Introduction: A published 2022 clinical protocol for enoxaparin dosing in trauma patients had never been implemented in our facility. The dosing strategy to date was enoxaparin 30 mg subcutaneously twice daily, with renal and weight adjustments as indicated. The purpose of this project was to implement the 2022 clinical protocol via an order-set creation and comparing differences with previous dosing strategies to include compliance with protocol and adverse event rates in adult trauma patients.
Methods: This single-center study evaluated patients 18 years of age or older admitted to Huntsville Hospital through trauma services. Data was reviewed for selected patients from January 1, 2024, through January 31, 2025. Data was collected from the electronic health record and analyzed using descriptive statistics; Chi-Square was used to compare VTE rates. Demographics, laboratory values, VTE events, and drug related events were collected. Comparison between dosing strategies were compared to the 2022 published protocol. Quality improvement process steps were completd using PDCA cycles.
Results: A total of 160 patients were studied with 80 patients each group. Both groups had similar baseline characteristics. Adherence to the protocol was 44% in the pre-implementation group and 84% in the post-implementation group. No anti-Xa levels were obtained in the pre-implementation group. In the post-implementation group, target range anti-Xa values were achieved in 87% of patients. The incidence of VTE events was not statistically significant (p=0.608) between groups with 13% in pre-implementation group versus 9%, reflecting the need for larger study size. Three quality improvements were made during the implementation steps to improve the process modifying the original order-set.
Conclusions: Compliance with a published algorithm for VTE prophylaxis in trauma patients was achieved with increased education to prescribers and order set creation leading to over 80% of dosing strategies matching the published algorithm. The quality improvement changes made during this project helped increase compliance with the protocol dosing adjustments, reduced erroneous laboratory values, and reduced pharmacy time for making interventions.
