Department of Pharmacy, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am J Med. 2010 Jun;123(6):536-41. doi: 10.1016/j.amjmed.2009.11.017.
We compared adherence to unfractionated heparin (UFH) 2 or 3 times daily prophylaxis orders versus low-molecular-weight heparin (LMWH) once daily orders. Our goals were to determine which strategy demonstrated the best adherence in terms of timing and frequency of dose administration, and to determine reasons for ordered heparin not being administered.
We queried our electronic medication administration record where nurses document reasons for delayed administration or omitted doses. We identified 250 consecutive patients who were prescribed prophylaxis with UFH 2 or 3 times daily or LMWH once daily. We followed patients for their hospitalization to determine adherence to physicians' prophylaxis orders.
Adherence, defined as the ratio of prophylaxis doses given to doses ordered, was greater with LMWH (94.9%) than UFH 3 times daily (87.8%) or UFH twice daily (86.8%) regimens (P <.001). Patients receiving LMWH more often received all of their scheduled prophylaxis doses (77%) versus UFH 3 times daily (54%) or UFH twice daily (45%) (P <.001). There were no differences between regimens regarding reasons for omitted doses. The most common reason for late or omitted doses was patient refusal, which explained 44% of the UFH and 39% of the LMWH orders that were not administered.
LMWH once a day had better adherence than UFH 2 or 3 times daily. For both LMWH and UFH, patient refusal was the most common reason for not administering prophylaxis as prescribed. These findings require consideration when evaluating pharmacological prophylaxis strategies. Educational programs, explaining the rationale, may motivate patients to improve adherence during hospitalization.
我们比较了每日 2 或 3 次给予未分馏肝素（UFH）与每日 1 次给予低分子肝素（LMWH）预防治疗医嘱的依从性。我们的目标是确定哪种策略在给药时间和频率方面表现出最好的依从性，并确定未给予肝素的原因。
我们查询了电子医嘱记录，其中护士记录了延迟给药或漏用剂量的原因。我们确定了 250 例连续接受 UFH 每日 2 或 3 次或 LMWH 每日 1 次预防治疗的患者。我们对患者进行了住院期间的随访，以确定对医生预防治疗医嘱的依从性。
以给予的预防剂量与医嘱剂量的比值定义的依从性，LMWH（94.9%）明显高于 UFH 每日 3 次（87.8%）或 UFH 每日 2 次（86.8%）方案（P<.001）。接受 LMWH 的患者更常接受所有预定的预防剂量（77%），而 UFH 每日 3 次（54%）或 UFH 每日 2 次（45%）的患者则较少（P<.001）。在漏用剂量的原因方面，不同方案之间没有差异。漏用剂量的最常见原因是患者拒绝，这解释了 44%的未给予 UFH 和 39%的 LMWH 医嘱。
LMWH 每日 1 次的依从性优于 UFH 每日 2 或 3 次。对于 LMWH 和 UFH，患者拒绝是未按规定给予预防治疗的最常见原因。在评估药物预防策略时需要考虑这些发现。解释原理的教育计划可能会激励患者在住院期间提高依从性。
