Title: OSHP NPSG3E Anticoagulation Workshop
1OSHP NPSG-3E Anticoagulation Workshop
- Susan Fugate, Pharm.D., BCPS, CACP
- University of Oklahoma College of Pharmacy
- INTEGRIS Baptist Southwest Anticoagulation
Clinics
2INTEGRIS
- Baptist Medical Center
- 508 bed hospital
- Southwest Medical Center
- 368 bed hospital
- Anticoagulation Clinics
- Comprehensive outpatient warfarin management
- 1000 patients
- http//www.integris-health.com/integris/en-us/spec
ialties/a-f/anticoagulation
3National Patient Safety Goals (NPSG)
- NPSG.03.05.01
- Reduce the likelihood of patient harm associated
with the use of anticoagulation therapy - Rationale
- High-risk treatment commonly leading to ADE due
to complex dosing, follow-up monitoring,
inconsistent compliance - Standardized practices can reduce risk of ADEs
associated with UFH, LMWH, and warfarin
4NPSG.03.05.01 Timeline
- 4/1/08 Responsibility assigned for oversight
and coordination - 7/1/08 Implementation plan in place
- 9/1/08 Pilot testing in at least 1 clinical unit
- 1/1/09 Full implementation
5NPSG.03.05.01Elements for Performance
- 1. The hospital implements a defined
anticoagulation management program to
individualize the care provided to each patient
receiving anticoagulation therapy. - Example
- Anticoagulation management services
- Anticoagulant committee to develop processes and
protocols to be used throughout the institition
6NPSG.03.05.01Elements for Performance
- 2. To reduce compounding and labeling errors, the
hospital uses only oral unit dose products,
pre-filled syringes, or pre-mixed infusion bags
when these products are available. - Note For pediatric patients, pre-loaded syringe
products should only be used if specifically
designed for children.
7NPSG.03.05.01Elements for Performance
- 3. The hospital uses approved protocols for the
initiation and maintenance of anticoagulation
therapy appropriate to the medication used, to
the condition being treated, and to the potential
for medication interactions. - Examples
- Warfarin protocols
- Pharmacist or nurse driven dosing
- Support structure to physician dosing
- UFH/LMWH
- Treatment dosing/indications
- Prophylactic dosing/indications
831 hospital survey
- Surveyed ACCP Cardiology and Critical Care list
serves - 58 had 2 UFH order sets
- 23 had 3 UFH order sets
- Majority for DVT/PE and ACS
- 74 have been evaluated
- 45 had pharmarcy-managed anticoagulation
services - 97 used aPTT to monitor UFH
9NPSG.03.05.01Elements for Performance
- 4. For patients starting on warfarin, a baseline
INR is available, and for all patients receiving
warfarin therapy, a current INR is available and
is used to monitor and adjust therapy. - Examples
- Automatic INR order upon warfarin initiation in
warfarin-naïve patients - Automatic INR daily orders (prescriber may alter
to no greater than weekly testing) - Responsible party for review of INR prior to dose
administration
10NPSG.03.05.01Elements for Performance
- 5. When dietary services are provided by the
hospital, the service is notified of all patients
receiving warfarin and responds according to its
established food/medication interaction program. - Examples
- Warfarin education booklet
- USDA vitamin K food list
- Dietary services provide education to all
patients
11NPSG.03.05.01Elements for Performance
- 6. When heparin is administered IV and
continuously, the hospital uses programmable
infusion pumps in order to provide consistent and
accurate dosing.
12NPSG.03.05.01Elements for Performance
- 7. The hospital has a written policy that
addresses and ongoing laboratory tests that are
required for UFH and LMWH therapies. - Examples
- Therapeutic monitoring
- Safety monitoring
- May incorporate into medication use protocols
13NPSG.03.05.01Elements for Performance
- 8. The hospital provides education regarding
anticoagulation therapy to prescribers, staff,
patients, and families. - Note Patient/family education includes the
importance of follow-up monitoring, compliance
issues, dietary, restrictions, and potential for
ADRs and interactions. - Examples
- AHRQ warfarin booklet (English/Spanish)
- LMWH discharge kits
- Prescriber/staff meeting in-services and
newsletter update
14NPSG.03.05.01Elements for Performance
- 9. The hospital evaluates its anticoagulation
safety practices, takes appropriate action to
improve its practices, and measures the
effectiveness of those actions on a regular
basis. - Examples
- Assessment of patient outcomes and therapeutic
control
15Additional Joint Commission Expectations
- Standardized list of abbreviations
- Standardize and limit the of drug
concentrations used - Accurately and completely reconcile meds across
the continuum of care - Identify and at a minimum annually review
look-alike/sound-alike drugs
16Additional Joint Commission Expectations
- Implement a standardized approach to hand off
communications - Measure, assess, and if appropriate, take action
to improve timeliness of reporting receipt of
critical tests results - Encourage patients active involvement in their
own care as a patient safety strategy
17Resources
- 2008 CHEST recommendations www.chestjournal.org
- AHRQ www.ahrq.gov
- USDA www.usda.gov
- Pharmaceutical industry websites/reps
- Managing Anticoagulation Patients in the
Hospital 107 www.ashp.org
18Resources
- Anticoagulant toolkit http//www.purdue.edu/dp/rc
he/pharmatap/toolkit.pdf - Live WEBINAR NPSG 3E Myths Reality 8/21
www.1.gotometting.com/register/862541958 - OSHP workshop summary
- www.oshp.net