MP31: Optimizing ketorolac dosing by leveraging computerized order entry

Background: Ketorolac has long been used to manage pain in the Emergency Department and has the advantage of being the only parenteral NSAID formulation. Despite multiple studies demonstrating an analgesic ceiling dose of 10mg for intravenous ketorolac, higher doses (30-60mg) are commonly ordered. Use of optimal doses of ketorolac (10mg) has the advantage of lower side effects and cost. Aim Statement: The aim of this project was to increase the usage of the optimal dose parenteral ketorolac (10mg) without increasing the use of additional, concomitant or rescue opioids (balancing measures). Measures & Design: This pre-/post-intervention comparison study (May 1, 2016 to April 30, 2018) included all patients ≥18 years of age that received parenteral ketorolac at one of 4 EDs in the Calgary zone. All data was captured via administrative data records. Stakeholders (ED leadership, analgesia committee, nursing and pharmacy) provided feedback and support for the project. Our multi-modal intervention included modifying all ED computerized order sets such that the default parenteral ketorolac dose was 10mg (post-intervention) from 30mg (pre-intervention), education (dissemination of evidence to support the changes to clinicians) and our pharmacy securing 10mg vials of ketorolac. At their discretion, physicians’ were still able to order other doses of ketorolac. Evaluation/Results: During the 2 year study period, 19290 patient records were identified where parenteral ketorolac was administered during the ED visit. Baseline characteristics were similar between the pre/post periods. Prior to the change in default dosing, 10.5% of orders were for ketorolac 10mg compared to 87% in the post-intervention period (p < 0.000). Statistical process charts support the above results and demonstrate that the changes have been sustained. There were no differences in patients receiving ketorolac as the only analgesic between the pre/post periods (42% vs 42%, p = 0.396), nor where there significant changes in concomitant opioid usage (46% vs 46%, p = 0.817), or rescue analgesia (11% vs 12%, p = 0.097). Discussion/Impact: In this large cohort, our multi-modal intervention, resulted in a significant increase in optimal ketorolac parenteral dosing without a significant change in additional opioid use. The results support the utility of computerized order set changes as the cornerstone of an effective and rapid knowledge translation strategy to align physician practice with best evidence.

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Turbidity reduction in drinking water by coagulation-flocculation with chitosan polymers

Journal of Water and Health ◽

10.2166/wh.2019.114 ◽

2019 ◽

Vol 17 (2) ◽

pp. 204-218 ◽

Cited By ~ 7

Author(s):

Ampai Soros ◽

James E. Amburgey ◽

Christine E. Stauber ◽

Mark D. Sobsey ◽

Lisa M. Casanova

Keyword(s):

Drinking Water ◽

Functional Groups ◽

Dose Range ◽

Optimal Dose ◽

Global Network ◽

Point Of Zero Charge ◽

Household Water ◽

Generous Support ◽

Higher Doses ◽

Model Household

Abstract Turbidity reduction by coagulation-flocculation in drinking water reduces microbes and organic matter, increasing effectiveness of downstream treatment. Chitosan is a promising household water coagulant, but needs parameters for use. This study tested the effects of chitosan dose, molecular weight (MW), degree of deacetylation (DD), and functional groups on bentonite and kaolinite turbidity reduction in model household drinking water. Higher MW or DD produced greater reductions. Highest reductions were at doses 1 and 3 mg/L by MW >50,000 or >70% DD (residual turbidity <5 NTU). Higher doses did not necessarily continually increase reduction. For functional groups, 3 mg/L produced the highest reductions by lactate, acetate, and HCl, and lower reductions of kaolinite than bentonite. Doses where the point of zero charge was observed clustered around 3 mg/L. Chitosan reduced clay turbidity in water; effectiveness was influenced by dose, clay type, MW, DD, and functional groups. Reduction did not necessarily increase with MW. Bentonite had a broader effective dose range and higher reduction at the optimal dose than kaolinite. Chitosans with and without functional groups performed similarly. The best of the studied doses was 3 mg/L. Chitosans are promising for turbidity reduction in low-resource settings if combined with sedimentation and/or filtration. This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.

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Multidisciplinary Approach to Improve Utilization and Cost Savings of Multiplex Polymerase chain reaction (PCR) Respiratory Pathogen Testing in a Large Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.853 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S353-S354

Author(s):

Ali Hassoun ◽

Jonathan Edwards

Keyword(s):

Nasal Swab ◽

Community Hospital ◽

Clinical Information System ◽

Retrospective Chart Review ◽

Respiratory Pathogen ◽

Intervention Period ◽

Post Intervention ◽

Large Community ◽

Intervention Cost ◽

Order Sets

Abstract Background PCR technology can be used for precise detection of infectious agents and improves antibiotic stewardship through: Accelerated de-escalation of therapy Rapid identification of pathogens Detection of resistance genes. In our center, basic respiratory Panel detect 11 targets and cost $100 while Complete panel detect 31 targets and cost $230.The purpose of the study is to improve utilization of these panel testing in a large community hospital. Methods Retrospective chart review of all patients with an order for a complete or basic panel and excluding Patients discharged or deceased prior to result reporting or insufficient specimen quantity to perform. Each patient was evaluated for appropriate respiratory panel collection site and antibiotic regimen changes within 48 hours of results. The preintervention period conducted from 10/2015- 12/2015, evaluated how respiratory panels were being utilized in antibiotic decision-making. Three primary interventions were enacted: Eliminated nasal swabs as a source option for respiratory panels in the clinical information system, restricted complete panel ordering to ID physicians and Eliminated PCR ordering options from all order sets. The postintervention period conducted from 5/2016 – 8/2016, re-evaluated the utilization and costs of respiratory panels. Results 270 tests ordered preintervention (13% basic and 87% complete) and 196 postintervention (84% basic and 16% complete), nasal swab was done in 78% in preintervention vs. 8% in postintervention, action was taken in 51 vs. 44 in pre-vs. post intervention. cost in preintervention period was 57,420 in preintervention vs. 23,660 in post intervension. No difference between ID vs. non-ID specialist in utilization of PCR. Conclusion Nasal swab collections for PCR decreased post-intervention from 78% to 8%. Appropriate sources for PCR specimen, such as sputum, were utilized during the post-intervention period. Post-intervention utilization of the panel results was comparable to pre-intervention period. Elimination of PCR respiratory panels from order sets and restrictions of complete respiratory panel ordering to ID physicians resulted in $33,760 saved. Disclosures All authors: No reported disclosures.

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Regulation of monocyte procoagulant by chemoattractants

Blood ◽

10.1182/blood.v65.3.545.545 ◽

1985 ◽

Vol 65 (3) ◽

pp. 545-552 ◽

Cited By ~ 13

Author(s):

RL Janco ◽

PJ Morris

Keyword(s):

Kinetic Studies ◽

Optimal Dose ◽

Procoagulant Activity ◽

Factor Vii ◽

High Dose ◽

Fourfold Increase ◽

Leukocyte Function ◽

Chemotactic Peptides ◽

Higher Doses

Abstract Various n-formylated peptides function as receptor-specific chemoattractants for both granulocytes and monocytes. Because these agents are important tools in the study of leukocyte function in vitro, we chose to examine their effects on leukocyte procoagulant activity. The synthetic chemotactic peptide N-formyl-methionyl-leucyl phenylalanine (FMLP) induces a fourfold increase in procoagulant activity (PCA) in cultured human monocytes at an optimal dose of 5 X 10(-9) mol/L, whereas higher doses inhibit PCA response. Although nonadherent lymphocytes are not absolutely required for PCA expression, their presence significantly amplifies monocyte PCA. Irradiation of nonadherent lymphocytes before mixing them with FMLP and adherent cells abolishes their ability to amplify PCA. Kinetic studies demonstrate an increase in optimal dose FMLP-stimulated PCA over time whereas high- dose inhibition of PCA generation occurs at various incubation times. Cell viability is unaffected by inhibitory concentrations of FMLP. Supernates from high-dose FMLP-stimulated cells fail to inhibit later expression of PCA by cells exposed to endotoxin. The cellular procoagulant remains cell-bound and exhibits characteristics of thromboplastin (tissue factor), including inhibition by concanavalin A and phospholipase C as well as the ability to shorten the clotting times of factor VIII but not factor VII-deficient substrate plasmas. These results suggest a complex system of lymphoid cell regulation of procoagulant generation by monocytes exposed to various chemotactic peptides in vitro.

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Improving the assessment and documentation of constipation at UF Health Cancer Center through mandatory prompts.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.263 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 263-263

Author(s):

Brian Hemendra Ramnaraign ◽

Bilal Farooqi ◽

Priya Kadambi Gopalan ◽

Merry Jennifer Markham

Keyword(s):

Hospital Admissions ◽

Medical Oncology ◽

The Other ◽

Cancer Center ◽

Intervention Period ◽

Opioid Use ◽

Academic Hospital ◽

Post Intervention ◽

Chart Abstraction ◽

Oncology Practice

263 Background: Opioids are commonly prescribed to patients for management of pain and the most common and persistent side effect from opioid use is constipation. Opioid-induced constipation (OIC) affects 52% of patients with advanced cancer and 87% of terminally ill patients. In the Spring 2017 Quality Oncology Practice Initiative (QOPI) chart abstraction round, UF Health Cancer Center’s Medical Oncology clinic notes documented the assessment of constipation in only 45.45% of charts. This is below the academic hospital aggregate documentation rate of 55.61%. Methods: Our objective was to improve the rate of documentation of assessment of constipation in the Thoracic Oncology Clinic at UF Health Cancer Center by 33% to a goal rate of at least 60% by 3 months. We used a Plan-Do-Study-Act model in order to design our project. We worked with the EPIC developers to include a mandatory prompt at the end of the assessment/plan section of the clinic template notes for the Thoracic Oncology practice. Our prompt was “Constipation was addressed and @HE@ {DOES/DOES NOT} have symptoms” where the author chooses from a drop down list to select whether the patient “does” or "does not” have symptoms. We planned to assess a total of 60 random charts in the 3 month post intervention period. Results: At the end of our study, a total of 48 out of 60 charts (80%) documented constipation thus surpassing our goal of 60%. Of the 12 charts assessed that did not address constipation, 11 did not use our revised templates and were notes that were “copied forwarded” from previous encounters. Conclusions: Given that our intervention was a success, we plan to expand these revised templates to the other medical oncology subspecialties in order to better document assessment of constipation for all cancer patients. While our mandatory prompt was shown to lead to increased documentation of constipation, further studies to show whether or not this leads to decreased complaints of abdominal pain, decreased incidences of bowel obstructions, and/or decreased hospital admissions, would be interesting to pursue.

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State-wide quality improvement addressing overutilization of neurokinin-1 receptor antagonists.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.8 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 8-8

Author(s):

Emily R. Mackler ◽

Kelly Marie Procailo ◽

Louise Bedard ◽

Jennifer J. Griggs

Keyword(s):

Quality Improvement ◽

Response Rate ◽

Quality Improvement Intervention ◽

Receptor Antagonists ◽

Post Intervention ◽

Improvement Program ◽

Neurokinin 1 Receptor ◽

Order Sets ◽

Neurokinin 1 ◽

Order Set

8 Background: The overuse of neurokinin-1 receptor antagonists (NK1-RAs) is a focus of quality measurement within the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO-QOPI) and the American Board of Internal Medicine (ABIM) as a Choosing Wisely measure. The Michigan Oncology Quality Collaborative (MOQC) is a statewide collaborative with participation of nearly 100% of oncologists. The purpose of this project was to provide quality improvement practice support for deimplementation of NK1-RAs in the upfront prevention of chemotherapy- induced nausea and vomiting (CINV) for low and moderate emetic chemotherapy regimens (QOPI measure SMT28a) to less than 30% in practices across the State, with lower scores indicating better performance. Methods: In 2018, MOQC added the QOPI SMT28a measure as part of its standard quality measure module for collection by all MOQC practices. A quality improvement intervention was initiated that consisted of 1) baseline assessments of measure performance, prescriber knowledge and beliefs, and pre-populated antiemetic order sets, 2) reporting practice and state-level performance to MOQC practices, 3) state-wide CINV education, and 4) a value-based reimbursement (VBR) related to measure performance. Post-intervention performance was assessed with the Fall 2019 and Spring 2020 QOPI-measurement. Results: Responses from a survey assessing pre-populated antiemetic order sets (32/43, 74% response rate), 23% of practices had a pre-populated order set for NK1-RA and/or olanzapine in moderate emetic regimens. The post-education order set survey found that 48% of respondents (25/43, 54% response rate) either modified or were in the process of modifying their order sets. Conclusions: Deimplementation of unnecessary and low value antiemetics in patients receiving low- or moderate emetic chemotherapy was possible via a state-wide quality improvement program that involved performance reporting to practices, collaborative-wide education, modification of standing order sets, and VBR based on performance. [Table: see text]

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Nicotine and Opioid Polysubstance Abuse: Enhancement of opioid self-administration by systemic nicotine and modulation of opioid-associated memories by insular nicotine

10.1101/2020.09.07.286542 ◽

2020 ◽

Author(s):

Gregory C Loney ◽

Christopher P King ◽

Paul J Meyer

Keyword(s):

Insular Cortex ◽

Place Preference ◽

Treatment Programs ◽

Opioid Use ◽

Self Administration ◽

Taste Avoidance ◽

Contextual Conditioning ◽

Nicotine Pretreatment ◽

Polysubstance Abuse ◽

Higher Doses

AbstractConcurrent nicotine use is associated with increased liability for the development and exacerbation of opioid-use disorders. Habitual use of nicotine containing products increases propensity to misuse prescription opioids and its prevalence is substantially increased in individuals currently involved in opioid-treatment programs. Nicotine enhances self-administration of many classes of drugs in rodents, though evidence for direct effects on opioids is lacking. We sought to measure the effects of nicotine pretreatment on the reinforcing efficacy of opioids in both self-administration and contextual conditioning paradigms. First, we measured the effect of systemic nicotine pretreatment on self-administration of two opioids. Additionally, we measured the degree to which systemic nicotine pretreatment impacts the formation of morphine-associated contextual memories in conditioned taste avoidance and place preference paradigms. Given the involvement of the insula in the maintenance of substance abuse, its importance in nicotine addiction, and findings that insular inactivation impairs contextual drug conditioning, we examined whether nicotine administered directly to the insula could recapitulate the effects of systemic nicotine. We demonstrate that systemic nicotine pretreatment significantly enhances opioid self-administration and alters contextual conditioning. Furthermore, intra-insula nicotine similarly altered morphine contextual conditioning by blocking the formation of taste avoidance at all three morphine doses tested (5.0, 10, & 20 mg/kg), while shifting the dose-response curve of morphine in the place preference paradigm rightward. In conclusion, these data demonstrate that nicotine facilitates opioid intake and is partly acting within the insular cortex to obfuscate aversive opiate memories while potentiating approach to morphine-associated stimuli at higher doses.

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2084. Implementation of a Diagnostic Stewardship Algorithm by Bedside Nurses to Reduce Unnecessary Urinary Cultures in Hospitalized Adult Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1764 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S703-S704

Author(s):

Valeria Fabre ◽

Ashley Pleiss ◽

Zoe Demko ◽

Anna Sick-Samuels ◽

Lauri Hicks ◽

...

Keyword(s):

Asymptomatic Bacteriuria ◽

Control Unit ◽

Johns Hopkins Hospital ◽

Post Intervention ◽

Statistical Process ◽

Team Members ◽

Before And After ◽

Algorithm Implementation ◽

The Impact ◽

Intervention Unit

Abstract Background Urine cultures (UCx) are often ordered in patients without symptoms of urinary tract infection. A pilot study was conducted to assess the impact of a nurse-driven UCx diagnostic stewardship intervention for adult inpatients. Methods We interviewed eight nurses to determine the feasibility of a nurse-driven UCx stewardship intervention. Based on their feedback, an algorithm with appropriate indications for UCx was developed (Figure 1) and approved by physicians and nurses for piloting on a 24-bed medicine unit at The Johns Hopkins Hospital. UCx orders/100 patient-days (PD) were trended with statistical process charts in the intervention and a control unit. Nurses used the algorithm to guide discussions with ordering providers and to suggest instances where UCx may be unnecessary (“intervention”). Nurses were educated on an antibiotic (abx) use safety and appropriate testing during live sessions prior to algorithm implementation. Two study team members reviewed all UCx ordered in the intervention unit 12 months before and 6 months after the intervention for appropriateness based on algorithm criteria. Feedback on UCx order appropriateness and case-based discussion were provided to nurses via in-person meetings post intervention. Data were compared using the χ 2 or the Mann–Whitney test as appropriate. The rate of UCx orders before and after the intervention were compared using a standard incident ratio (IRR). Results With algorithm implementation, the mean rate of UCx orders/100 PD decreased from 2.7 to 1.8 (39% decrease) in the intervention unit (IRR 0.61, 95% confidence intervals (CI) 0.45–0.82, P = .16). Mean UCx order rates in the control unit were 2.49 and 2.99, respectively (Figure 2). Characteristics of patients reviewed for appropriateness were similar between the two study periods: median age 63 (IQR 39, 74) vs. 56 (IQR 45, 76), female sex 65% vs. 61%, on hemodialysis 7% vs. 11%, urinary catheter present 20% vs. 29%. The proportion of inappropriate UCx decreased from 59% (98/165) to 50% (32/64) (P = 0.16). There were 8 and 1 cases of asymptomatic bacteriuria inappropriately treated in the pre- and post-intervention periods, respectively (42 and 7 abx days). Conclusion With the appropriate training and tools, nurses can steward UCx and reduce unnecessary testing and abx use Disclosures Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant.

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1046. Evaluating the outcomes of embedding Antimicrobial Stewardship order sets in the General Medicine Admission Electronic Order Set: A Retrospective Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.910 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S368-S369

Author(s):

April Chan ◽

Ajay Kapur ◽

Bradley Langford ◽

Mark Downing

Keyword(s):

Antimicrobial Stewardship ◽

General Medicine ◽

Fold Increase ◽

Antibiotic Usage ◽

Intervention Period ◽

Post Intervention ◽

Days Of Therapy ◽

Order Sets ◽

The Impact ◽

Electronic Order

Abstract Background The use of facility-specific guidelines and clinical decision-making tools are recommended by a number of organizations to improve the appropriateness of empiric antimicrobial prescribing; however, how to increase usage is not clear. We evaluated the impact of embedding antimicrobial stewardship (AS) electronic order sets (EOS) into the general medicine admission EOS in the context of an established AS program. Methods The standalone EOS for community-acquired pneumonia (CAP), urinary tract infection (UTI) and cellulitis were reviewed and simplified to only include the antibiotic section prior to embedding. The intervention was introduced on March 30, 2017 with pre-intervention period defined as January 1, 2016 to March 29, 2017 and post-intervention period as of March 30, 2017 to June 30, 2018. The primary outcome was the change in usage of embedded AS EOS compared with the corresponding standalone EOS using counts. In addition, other standalone AS EOS (i.e., Clostridioides difficile infection (CDI), etc) were used as a control. The secondary outcomes were the change in antibiotic usage de-emphasized in embedded EOS (i.e., ceftriaxone, ciprofloxacin, clindamycin, moxifloxacin) and predicted prescribing shifts to antibiotics in the embedded EOS (i.e., amoxicillin-clavulanate, azithromycin and sulfamethoxazole-trimethoprim) using Days of Therapy (DOT)/1000 patient-days (PD). Paired t-test was used to compare antibiotic usage pre- and post-intervention. Results The usage of standalone EOS remained similar pre- and post-intervention except for a 16-fold increased usage of CDI EOS. There were large increases in uptake of the embedded EOS compared with the standalone EOS: 11-fold () increase for CAP, 47-fold () increase for UTI and 24-fold () increase for cellulitis. In addition, there was a statistically significant decrease in ciprofloxacin (mean 16.6 DOT/1000-PD vs. 13.6 DOT/1000-PD, P = 0.026) and moxifloxacin usage (mean 9.3 DOT/1000-PD vs. 5.2 DOT/1000-PD) during the study time period. Conclusion Our study showed that simplifying AS EOS and embedding these into a more commonly used EOS is associated with a significant increase in EOS usage and uptake of AS recommended empiric antibiotics with a decrease in fluoroquinolone usage. Disclosures All authors: No reported disclosures.

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Utilizing a standardized order set to increase speech pathology referrals in head and neck cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.324 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 324-324

Author(s):

Carly Gerretsen ◽

Corrine Jurgens

Keyword(s):

Head And Neck ◽

Chart Review ◽

Speech Pathology ◽

Post Intervention ◽

Referral Rates ◽

Order Sets ◽

Rate Of Speech ◽

Order Set

324 Background: Treatment of head and neck cancers may include radiation, and side effects will result in short and long-term dysphagia. This can lead to feeding tube usage, malnutrition, loss of social interaction, and reduced quality of life. Rehabilitation therapies are available with speech pathologists to improve outcomes. Evidence supports initiating therapy prior to radiation. Computerized order entry systems (CPOE) support standardization of evidence- based order sets. The purpose of this study was to examine the effect of a standardized order set on referral rates to speech pathology in adult patients undergoing radiation treatment for head and neck cancer. Methods: A quality improvement project was implemented an outpatient oncology clinic within an academic hospital using the PDSA format. Approval was obtained through the hospitals quality assurance officer, and it was determined that IRB approval was not necessary. A chart review was completed to assess the rate of speech pathology consults. A brief education program targeting ordering providers was completed including demonstration of the order set. Post intervention chart review was performed to assess the change in referral rates. Results: A chi square analysis was used to compare the difference in referral rates and found to be statistically significant, x² (1, n = 56) = 17.147, p < 0.01. Demographic data was analyzed using descriptive statistics. The sample was mostly Caucasian (82%), male (84%) with an average age of 63. The most common cancer diagnosis was larynx (36%). The percentage of referrals post intervention (82%) was significantly higher than pre-intervention (18%) consistent with the hypothesis that a standardized order set would increase speech referral rates. Conclusions: Use of a CPOE system with standardized order sets increased the rate of speech pathology referrals. The success of this order set has led to an expansion of the project, and creation of additional order sets. Standardized computerized order sets should be considered to increase referrals to underutilized ancillary services. Providers should be encouraged to create relationships with these services to improve patient’s quality of life and long- term outcomes.

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Higher Doses of Prophylactic Anticoagulation Is More Effective in Preventing Venous Thromboembolism in Morbidly Obese Inpatients.

Blood ◽

10.1182/blood.v120.21.2268.2268 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2268-2268

Author(s):

Tzu-Fei Wang ◽

Paul Milligan ◽

Catherine A Wong ◽

Mark S Thoelke ◽

Eli N Deal ◽

...

Keyword(s):

Venous Thromboembolism ◽

Healthcare System ◽

Conflicts Of Interest ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Optimal Dose ◽

Morbidly Obese ◽

Number Needed To Treat ◽

Prophylactic Anticoagulation ◽

Higher Doses

Abstract Abstract 2268 Background: Obesity increases the risk for venous thromboembolism (VTE), and the optimal dose of prophylactic anticoagulation to prevent VTE in morbidly obese inpatients is unknown. Objectives: To quantify the efficacy and safety of higher doses of prophylactic heparin or enoxaparin for VTE prevention in morbidly obese inpatients with a body mass index (BMI) ≥ 40 kg/m2and/or weight >100 kg within the BJC HealthCare system. Patients/Methods: We analyzed 10,239 inpatients with weight > 100 kg and/or morbid obesity (BMI ≥ 40 kg/m2) discharged from the three major hospitals in the BJC HealthCare system from January 1st, 2010 through February 29th, 2012. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) and Wald's chi-square to compare proportions. The primary efficacy outcome was an ICD-9 diagnosis code for VTE. The primary safety outcome was an ICD-9 diagnosis codes for bleeding. Results: On-treatment analysis showed higher doses of prophylactic anticoagulation (heparin 7500 units three times daily instead of 5000 units two or three times daily or enoxaparin 40 mg twice daily instead of 40 mg once daily) halved the risk (OR 0.52, 95% CI 0.27–1.00; p = 0.05) of symptomatic VTE in the 3928 morbidly obese inpatients (weight > 100kg and BMI ≥ 40 kg/m2). The rate of VTE was 1.48% (35/2369) in these morbidly obese inpatients who received standard prophylactic doses of unfractionated heparin or enoxaparin, compared to 0.77% (12/1559) in those who received higher doses, with an absolute risk reduction of 0.71% and a number needed to treat (NNT) of approximately 140. Intention-to-treat analysis failed to show reduction in VTE rate due to low (< 40%) physician compliance in prescribing the higher doses. Increased doses of prophylactic anticoagulation were not associated with bleeding (OR 0.84, 95% CI 0.66–1.07, p = 0.15). Conclusions: Higher doses of prophylactic anticoagulation nearly halve the rate of VTE in morbidly obese inpatients (with BMI ≥ 40 kg/m2 and weight > 100 kg), but do not increase bleeding. Given their safety and ease of implementation, higher doses of prophylactic heparin or enoxaparin should be considered in morbidly obese inpatients. Clinicians' compliance and awareness need to be improved to prevent VTE in this vulnerable population. Disclosures: No relevant conflicts of interest to declare.

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