•Materials and Methods :  This quality improvement initiative was conducted at a tertiary academic center to improve adherence to anticoagulation safety standards in patients with epidural catheters. A standardized interdisciplinary workflow was developed targeting anesthesiology, surgery, nursing, and pharmacy teams. The intervention emphasized avoidance of intraoperative LMWH administration following epidural placement, substitution with unfractionated heparin (UFH) when required, appropriate enhanced documentation standards, mandatory interdisciplinary verification of epidural status, pharmacy-level dispensing hard-stops, and electronic health record (EHR) safety flags. Retrospective review of Acute Pain Service records was used to assess baseline compliance with anticoagulation guidelines and to identify episodes of inappropriate LMWH administration. This project received Institutional Research and Ethics Board Review exemption from Western University.

•Results : Baseline review identified multiple instances of LMWH (Dalteparin) administration intraoperatively after epidural catheter placement, contrary to current safety guidelines. Implementation of the standardized workflow improved interdisciplinary communication and clarified anticoagulant selection and timing. Key interventions included preoperative identification of epidural placement, intraoperative confirmation during surgical checklist, pharmacy hard-stops for LMWH dispensing, and visible chart reminders. Early auditing demonstrated improved compliance with UFH use during appropriate perioperative windows and elimination of inadvertent intraoperative LMWH dosing in patients with epidural catheters. Documentation accuracy and awareness of anticoagulation safety in the context of neuraxial techniques significantly improved across teams. Ongoing monitoring focuses on sustained compliance, neurologic surveillance adherence when indicated, and prevention of anticoagulant-related neuraxial complications.