From the Guidelines
The answer is b. Omission. This case represents an error of omission because the doctor failed to prescribe prophylactic heparin (an anticoagulant) that should have been given to prevent post-operative blood clots, as recommended by guidelines such as those outlined in 1. An omission occurs when a healthcare provider fails to take an action that should have been taken according to standard of care. In contrast, an error of commission would involve actively doing something incorrect (like prescribing the wrong medication), while a near miss would be an error that was caught before causing harm. Post-operative patients often have increased risk factors for thromboembolism due to immobility, surgical trauma, and inflammatory responses, which is why anticoagulant prophylaxis is commonly indicated, as supported by studies like 1 and 1. The doctor's failure to prescribe this preventive measure directly contributed to the patient developing a blood clot, making this a clear example of an error of omission in medical practice.
Some key points to consider in this scenario include:
- The use of low molecular weight heparin (LMWH) as a preferred option for thromboprophylaxis due to its once-daily administration and better pharmacokinetic profile, as noted in 1 and 1.
- The recommendation for extended prophylaxis for up to 4 weeks in high-risk patients, such as those undergoing major cancer surgery, as discussed in 1 and 1.
- The importance of considering the balance between the risk of venous thromboembolism (VTE) and the risk of bleeding when deciding on thromboprophylaxis, as highlighted in 1.
Overall, the failure to prescribe prophylactic heparin in this case is a clear example of an error of omission, with potential serious consequences for the patient's morbidity, mortality, and quality of life.
From the FDA Drug Label
Heparin Sodium Injection is indicated for: ... Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease A number of well-controlled clinical trials have demonstrated that low-dose heparin prophylaxis, given just prior to and after surgery, will reduce the incidence of postoperative deep vein thrombosis in the legs Low-Dose Prophylaxis of Postoperative Thromboembolism ... should be reserved for patients over the age of 40 who are undergoing major surgery.
The action of the doctor not prescribing anticoagulant as prophylactic heparin is:
- b. Omission as the doctor failed to provide the standard prophylactic treatment for postoperative deep venous thrombosis and pulmonary embolism, which is a low-dose regimen of heparin, as indicated in the drug label 2 and 2.
From the Research
Action Classification
The action of the doctor not prescribing anticoagulant as prophylactic heparin, resulting in the patient developing a blood clot post-op, can be classified as follows:
- Omission: This is the correct classification, as the doctor failed to take a necessary action (prescribing anticoagulant) to prevent a potential complication (blood clot) 3, 4, 5, 6, 7.
Key Points
Some key points to consider:
- Anticoagulant prophylaxis is effective in preventing deep vein thrombosis (DVT) in hospitalized medical patients 5.
- Low-molecular-weight heparin (LMWH) is a commonly used anticoagulant for prophylaxis and treatment of venous thromboembolism 3, 4, 6.
- The use of anticoagulants can compromise clotting parameters, but the difference between platelet counts of 30 × 10^9/l and 50 × 10^9/l may not be significant 7.
Relevant Studies
Relevant studies support the use of anticoagulant prophylaxis to prevent venous thromboembolism:
- A systematic review and meta-analysis found that anticoagulant prophylaxis reduces the risk of asymptomatic DVT in hospitalized medical patients 5.
- A study comparing LMWH and unfractionated heparin found that LMWH was superior in reducing the incidence of mortality and VTE events among trauma patients 4.