Assessing the effects of an indication-based panel for prescribing direct oral anticoagulants at discharge from the emergency department of an academic medical center

PURPOSE: Anticoagulants are one of the leading causes of adverse drug event-related emergency department (ED) visits and emergent hospitalizations, and high rates of inappropriate prescribing practices may be contributing. Nebraska Medicine implemented a direct oral anticoagulant (DOAC) indication-based prescribing panel on March 14, 2022. The goal of the panel is to assist with agent selection, dosing, and monitoring while ensuring indications and quantities are defaulted correctly. The purpose of this study was to assess the impact of an indication-based DOAC panel on appropriate prescribing in the ED. METHODS: This retrospective chart review included adult patients discharged from the ED with a new DOAC prescription before and after implementation of an indication-based prescribing panel from January 1, 2020, to March 13, 2022, and from July 1, 2022, to September 14, 2023, respectively. Data were analyzed using descriptive statistics, χ2 tests, and Student's t tests. RESULTS: A total of 200 patients were included in the final analysis, with 100 in each group. The primary outcome of inappropriate prescriptions occurred in 18% of patients in the pre-panel group and 7% of patients in the post-panel group (P = 0.020). The difference in the proportion of prescriptions requiring pharmacist involvement between the pre- and post-panel groups was statistically significant at 31% vs 17%, respectively (P = 0.020). There was no difference between the groups in the rate of return to the ED within 30 days for any indication. CONCLUSION: Implementation of an indication-based prescribing panel for DOACs led to a decrease in inappropriate prescribing of DOACs in the ED. Use of the panel decreased the need for pharmacist intervention and resources.