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Can Electronic Medical Record be used for Reducing DOAC Prescription Errors in Inpatients?

Friederike Steffen, Constantin von zur Mühlen, Armin Nemani, Timo Heidt, Johannes Schulte, Christoph Bode, Marvin Krohn-Grimberghe*

Background: Direct oral anticoagulants (DOACs) are commonly used for treating or preventing thromboembolic events. At the same time anticoagulants are a notorious cause of medication errors. Such medication errors can jeopardize patients’ health and challenge the economy of healthcare systems. With the potential of e-health systems for reducing medication errors, our study investigates the effects of medication highlighting.

Methods: To highlight medications with anticoagulatory properties in the electronic health records of cardiologic inpatients, a color scheme was introduced at our university hospital. We performed chart reviews of DOAC-related medication errors due to co-prescription of more than one anticoagulatory drug or omitted pausing of DOACs before interventions with increased bleeding risks. Chart reviews were performed before and after the introduction of medication highlighting. Patients having received a DOAC prescription at any point in time during their hospital stay were included.

Results: 305 (out of 1.045) patients had received DOAC before and 277 (out of 1.062) received DOAC within a three-month period after the color scheme introduction. DOAC-related medication errors occurred in 25 of the 305 (8.2%) inpatients in total before medication highlighting, while 6 errors occurred in 277 inpatients (2.2%; p= 0.0013) afterwards.

Conclusion: Highlighting anticoagulatory medications in the electronic medical record led to a reduction of DOACrelated prescription errors.