title: Compliance With Enoxaparin Dosing and Monitoring Guidelines and the Impact on Patient Length of Stay: A Pilot Study.
abstract: BACKGROUND
  To investigate the compliance of prescribers with the state-wide Queensland Health (QH) guidelines for dosing and monitoring of enoxaparin, and to examine the effect that compliance has on the patients' length of stay (LOS) in hospital.
  
  
  METHODS
  A 4-week retrospective study of consecutive inpatients who were administered enoxaparin for the treatment of an embolic disease. Data collected included influential patient demographics such as weight, renal function; details of antifactor Xa (aXa) monitoring, and patient LOS. All dosing and monitoring for each patient was compared to the current QH guidelines for enoxaparin usage; a multidisciplinary consensus document. The reasons for noncompliance were quantified and explored.
  
  
  RESULTS
  A total of 67 inpatients were recruited. The median (range) age, weight, and creatinine clearance of patients were 66 years (18-92), 78.5 kg (47.6-182), and 64 mL/min (16-180), respectively. Only 20 (30%) patients received enoxaparin in compliance with QH guidelines, leaving 47 (70%) noncompliant. The median (range) LOS was 7 (2-58) days for the compliant group versus 15 days (2-101) for the noncompliant (P = 0.06, Mann-Whitney U test). A total of 10 (15%) patients were monitored for aXa; none of whom were monitored correctly. Twenty-eight patients did not receive monitoring when indicated (moderate or severe renal impairment, weight >105 kg, or extended duration of therapy). In these patients, the median (range) LOS was 16.5 days (2-101).
  
  
  CONCLUSIONS
  Current prescribing of enoxaparin does not match state guidelines. Although not significant, there was a trend toward noncompliant patients having a greater LOS in hospital. The quality of aXa monitoring is suboptimal and barriers need to be explored. Larger studies are warranted.
authors.affiliation: *Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland; and†Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Katharine R
authors.initials: KR
authors.lastname: Dekker
authors.forename: Brooke L
authors.initials: BL
authors.lastname: Myers
authors.forename: Michael A
authors.initials: MA
authors.lastname: Barras
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000493:pharmacokinetics; D003404:Creatinine / Q000097:blood / Q000652:urine; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods*; D004617:Embolism / Q000188:drug therapy; D017984:Enoxaparin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011793:Queensland; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D003404:Creatinine