Following up on a medication error where a patient simultaneously took xarelto 15 mg twice daily and 20 mg daily, intended to start 21 days later, and presented to our facility with a serious bleed.

1. Does your facility have substantial prescribing of the Xarelto starter pack to provide clear instructions to the patient when to step down to the 20 mg daily dosing?
a. What processes have been implemented to encourage the use of the starter pack?
2. If your facility does not encourage the use of the starter pack, how do you ensure patient understanding of the instructions?

Juls
Yale-New Haven Hospital