Background HIT is a prothrombotic adverse drug reaction caused by heparin and requires an alternative anticoagulant: danaparoid. Because of its cost and the specific indication, the physicians must request two laboratory tests with prescriptions (LT: Platelet Aggregation Test, Anti PF4H) and a 4Ts assessment, in order to have danaparoid dispensed. Purpose To find out whether prescriptions are justified and if we can use the 4Ts score as a basis for HIT detection. Materials and Methods We analysed 5 years of prescriptions: 4Ts score results (the 4Ts assessment is used to arrive at a high (score 6 or more), intermediate (score 4–5) or low (score 3 or less) probability of HIT. Of 72 hospitalised patients followed (LT and/or prescription), 34 had a LT score without danaparoid prescription (32 negative and 2 positive results). 38 had a prescription that had been dispensed. 32 patients of these 38 had a 4Ts score. Looking at the 4 Ts’ results: 3.12% (1/32) patients had low score (LT not requested). 62.5% (20/32) came into the intermediate category (LT: 8/20 negative – 4/20 positive – uncertain 3/20 – not requested 5/20). 34.4% (11/32) came into the high-score group (LT: 4/11 negative – 4/11 positive – 1/11 uncertain – not requested 2/11). In 60.5% of the cases (23/38), the prescription was justified by a high score or a positive LT test or HIT diagnosed before. In 39.5% of the cases (15/38), a danaparoid prescription wasn’t justified: 7 patients still received danaparoid after negative LT results and 8 without a 4Ts score. Conclusions In our hospital, positive predictive value doesn’t match like it’s written in the literature. The 4Ts score doesn’t seem to favourably correspond with HIT laboratory testing results. A new scoring HIT Expert Probability Score is right now in validation. Will it be more suitable for our practise? No conflict of interest.
Background In our hospital, the medication system is totally managed by computers. When physicians sign the computerised prescription, an electronic sheet must be completed for controlled antibiotics. In 2011, pharmacists created a specific second part on the sheet about re-evaluating the antibiotic. Physicians can complete it 72 hours after initiation of empirical treatments as indicated in the recommendations. Purpose To evaluate the traceability of the re-evaluation of the antibiotic in the paper medical records and in the electronic antibiotics sheets. The results were compared with an audit conducted in 2010 of the re-evaluation in the paper medical records. Materials and Methods An audit grid was created to assess the traceability of the re-evaluation, the changes of antibiotic treatment after re-evaluation and re-evaluation deadlines. Results Of 50 medical records audited in the 5 hospital units, 12 were excluded because patients were hospitalised for less than 72 hours. 94.7% of empirical treatments were re-evaluated, 73. 5% of them before 72 hours (84% in 2010 and 90.7% of them before 72 hours). Physicians noted the re-evaluation in 58.3% of paper medical records (38.1% explicit re-evaluation, 61.9% implicit) versus 52% in 2010 (36.4% explicit re-evaluation, 63.6% implicit). 100% of electronic antibiotics sheets were completed: 25% by physicians and 75% by the pharmacist after calling the physicians. The re-evaluation led to treatment modification in 41.7% of the patients: change of the prescribed antibiotic (33.3%), change route of administration (26.7%), termination of treatment (20%), adding another antibiotic (20%). Conclusions The rate of re-evaluation on paper medical records wasn’t significantly different to the result from a first audit conducted in 2010. Thanks to the pharmacists’ involvement, traceability on electronic sheets is being noted correctly. The results will be passed on to the hospital antibiotics committee. Improvements will be proposed for better multidisciplinary collaboration between bacteriologists, pharmacists and physicians. No conflict of interest.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.