New order, pop-ups clarify when NOT to use anticoagulants

Some patients receive them anyway — how to avoid that

We’ve had several times where providers place orders to NOT give anticoagulation – but patients receive them anyway (for example, post-orthopedic surgery or hemorrhagic stroke).

The orders to avoid anticoagulants can be buried in the procedure orders, or not discontinued when no longer valid and lack the ability to remind a provider when they are about to violate the order.

What changes July 12:

If you enter one of the following orders: 





Then, attempt to order a therapeutic dose of enoxaparin, you will be prompted to remove the order you are attempting to place, or asked to discontinue the “No Anticoagulant” order.

The “DVT prophylaxis permitted” version of the order will pop up a reminder for therapeutic anticoagulation (e.g. heparin infusions), but not for VTE prophylaxis dosing (e.g. heparin 5,000 units subcutaneously q8h).

The logic also works in reverse (attempting to order the “No Anticoagulant” order with an active anticoagulant order will generate the subtle pop-up).

Anti-platelet agents and tranexamic acid are not included in this alert.

The following orders will be replaced with the appropriate version of the “No Anticoagulant” orders in order sets:

• No therapeutic doses while epidural catheter is in
• No Anticoagulants
• Anticoagulation – No

On the MAR, you will see one of the following orders:

If you have questions, suggestions or find ways it is not working as intended, contact Matt Tanner 503-814-9960 or matthew.tanner@salemhealth.org.