CC BY 4.0 · ACI open 2021; 05(02): e116-e124
DOI: 10.1055/s-0041-1736631
Case Report

Safe and Effective Digital Anticoagulation: A Continuous Iterative Improvement Approach

Jodie A. Austin
1  Faculty of Medicine, University of Queensland, Brisbane, Australia
2  Digital Application Services ieMR, eHealth Queensland, Brisbane, Australia
Michael A. Barras
3  The School of Pharmacy, University of Queensland, Brisbane, Australia
4  Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Australia
Clair M. Sullivan
1  Faculty of Medicine, University of Queensland, Brisbane, Australia
5  Metro North Hospital and Health Service, Brisbane, Australia
› Author Affiliations
Funding This research was supported by the Digital Health CRC through grant (STARS 0034).


Background Anticoagulant drugs are the leading cause of medication harm in hospitals and prescribing errors are common with traditional paper prescriptions. Electronic medicines management can reduce prescribing errors for many drugs; however, little is known about the impact of e-prescribing on anticoagulants. Our case study reports on the lessons learned during conversion from paper to e-prescribing and the ongoing optimization process.

Methods The iterative implementation of an anticoagulant prescribing platform in an integrated electronic medical record (ieMR) and ongoing continuous enhancements was applied across five digital hospital sites utilizing a single domain. The collaborative management of each class of anticoagulant, optimization strategies, governance structures, and lessons learned is described. An analysis of the rate of errors and adverse events pre- and post-go live is presented.

Results The transition to e-prescribing relied on a strong inter-disciplinary governance framework to promote the safe management of anticoagulants. There was no increase in overall prescribing errors, however unfamiliarity with the new system caused a transient increase in errors with unfractionated heparin (1.8/month pre-ieMR vs. 5.5/month post-ieMR). A dedicated real-time surveillance dashboard was introduced. The iterative nature of changes indicated the complexities involved with anticoagulants and the need for an interactive, optimization approach. This led to a significant decrease in anticoagulant related hospital acquired complications (12.1/month pre-ieMR vs. 7.8/month post-ieMR, p = 0.01).

Conclusion Digitizing anticoagulant prescribing led to an overall reduction in errors, but a continuous iterative optimization approach was needed to achieve this outcome. The knowledge presented can help inform optimal therapeutic anticoagulation ieMR design strategies.

Protection of Human and Animal Subjects

Ethics approval was sought and granted to publish this case report by the organization's Human Research Ethics Committee (Ref: LNR/2020/QMS/61139) on February 18, 2020 for low/negligible-risk research involving humans.

Publication History

Received: 18 September 2020

Accepted: 08 September 2021

Publication Date:
15 November 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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