Aim: To describe the anticoagulant effect, as assessed by initial activated partial thromboplastin time (APTT) results and time taken to reach the target APTT range, using a weight-based heparin protocol. A secondary aim was to assess the level of concordance with the protocol. Method: Records of 50 patients admitted to the coronary care unit via the emergency department during a relevant 2-month period with a preliminary diagnosis of unstable angina, myocardial infarction, chest pain or ischaemic heart disease and commenced on intravenous heparin, were retrospectively reviewed. Results: The initial APTT was documented for 98% (49/50) of patients. The proportion of initial APTTs > 100 seconds was 12% (6/49). Initial APTTs were within the therapeutic range (60-85 seconds) for 27% (13/49) of patients. The initial APTT was subtherapeutic (< 60 seconds) in 47% (23/49) of patients. The median time to a therapeutic APTT was 12.2 hours and the median time to the first measurement of APTT was 7.3 hours. The heparin order documented on the medication chart was concordant with the protocol 36% (18/50) of the time. There was no patient weight recorded on the medication chart 28% (14/50) of the time, and an incorrect starting heparin rate prescribed 18% (9/50) of the time. The desired APTT range was specified in 74% (37/50) of records reviewed. Overall, the rate was adjusted according to the protocol 70% (35/50) of the time. Conclusion: The evaluation of application of the weight-based heparin protocol has identified opportunities for practice improvement. Subsequent interventions include linking heparin prescribing protocol details with the existing electronic information systems at the point-of-care.

Background MND is a progressive neurodegenerative disorder with significant morbidity and mortality. The prevalence in Australasia is the second highest in the world with 12.9 cases per 100 000. Impairment of respiratory function contributes to and correlates with QOL. Respiratory complications are the most common causes of death. NIV improves or maintains QOL in patients with MND and prolongs median survival by up to 205 days in patients with normal to moderately impaired bulbar function. NICE guidelines recommend considering a trial NIV in those with symptoms, signs or evidence of impaired respiratory muscle strength. Methods A single centre, retrospective database and chart review of all incident and prevalent cases with two clinical interactions at the Princess Alexandra Hospital MND service between 2013-2021 was conducted. The primary aim was to determine the proportion of patients who trialed NIV. Secondary outcomes include: concordance with NICE Guidelines regarding NIV commencement, proportion of patients treated with riluzole and received PEG. Survival will be estimated by constructing Kaplan-Meier curves for those established on NIV compared with those that were not. Progress to date A total of 211 patients were included in analysis. 62.1% males, 37.9 % female, mean age at diagnosis 62.8 years. Limb phenotype was most common (52.5%) followed by bulbar phenotype (35.9%). 36.5% of the cohort trialed NIV. Further analysis to follow. Intended outcome and impact The outcomes will be compared with those published in the literature facilitating benchmarking of the service and identification of facets of patient care that can be improved.

Use of direct oral anticoagulants for acute pulmonary embolisms in obesity: a propensity matched multicenter case-control study.

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