Education together with a preprinted sticker improves the prescribing of prophylactic enoxaparin.

Introduction: Substantial evidence exists for the use of prophylactic heparin in medical inpatients with congestive heart failure and severe respiratory disease, and in surgical patients with a moderate-to-high risk of thromboembolism (Grade 1A recommendations). Despite this, many patients who would benefit from prophylaxis do not receive this treatment.

Methods: We implemented an education programme to promote the use of prophylactic enoxaparin. In addition, preprinted stickers were placed in the notes of patients to serve as a reminder, where appropriate, that the patient was a candidate for prophylaxis. To assess changes in practice, we undertook an audit of the charts of 105 medical patients and 100 surgical patients over a 3-month period before the intervention and a further 100 medical patients and 99 surgical patients over a 3-month period after the intervention.

Results: Before the campaign, prophylaxis with enoxaparin was used in 11% of eligible medical patients. Following the intervention, prophylaxis increased to 47% (95%CI 23-50, p<0.0001). The audit of surgical patients showed an increase in the use of enoxaparin from 36% of eligible patients to 50% (95%CI 0-28, p = 0.07) however there was no improvement in the proportion of those treated who received the appropriate dose according to guidelines.

Conclusion: Prophylactic heparin is under-used. An education programme together with the use of a sticker led to an improvement in the use of this treatment.