A quality improvement project conducted at London Health Sciences Centre in Ontario, Canada, supports use of a new system-level safeguard to prevent accidental administration of blood thinners after epidural catheter placement.
Epidural catheters are commonly used for pain management during and after surgery, but giving low molecular weight heparin (LMWH) too soon after placement can cause dangerous bleeding in the spinal area. To reduce this risk, a multidisciplinary team developed a standardized workflow involving anesthesiology, surgery, nursing, and pharmacy staff.
The intervention included preoperative identification of epidurals, intraoperative confirmation, pharmacy “hard-stops” to block inappropriate LMWH dispensing, electronic health record alerts, and improved documentation and communication across teams. Early audits showed that these measures eliminated inadvertent LMWH administration and improved adherence to safety guidelines.
“This quality improvement initiative demonstrates that inadvertent LMWH administration after epidural placement is a preventable, system-driven safety risk rather than an individual error,” the researchers concluded. By integrating team-based protocols, pharmacy safeguards, and electronic alerts, hospitals can enhance patient safety in perioperative care, they reported.
The American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine®) awarded “Safe HEP-EPI: Preventing Inadvertent LMWH Administration After Epidural Placement Through System-Level Anticoagulation Controls” with its biannual Patient Safety Award, which will be given at the 51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting, being held April 16-18 in Phoenix, AZ. The award recognizes projects that study and advocate for standardization and education into patient safety practices.
Primary author Sara H. Aldossary, MBBS, will present the abstract on April 17, 2026, at 4:30 pm during the session “Spinal Anesthesia for Ambulatory Surgery: Tips, Tricks, and Recipes.” Additional authors are Isam Bsisu, MD, Julio Gomez Tamayo, MD, and Tamer Attia, MD, of London Health Sciences Centre, London, Ontario, Canada.
