Guidelines for Safer Use of Anticoagulants in Hospitals

Diedtra Henderson

May 28, 2013

The risks of anticoagulants, which are associated with about 7% of all medication errors among hospitalized patients, can be reduced by actions such as using standardized dosing protocols that are accessible on every hospital floor and via the patient's electronic health records, according to consensus guidelines designed to improve health while reducing risks in the inpatient setting.

Edith A. Nutescu, PharmD, clinical professor in the Department of Pharmacy Practice and the Department of Administration and the Center for Pharmacoepidemiology and Pharmacoeconomic Research at the University of Illinois at Chicago, and coauthors published the guidelines in the May edition of the Annals of Pharmacotherapy.

Some 4 million Americans and 7 million patients worldwide are receiving anticoagulants, ranging from warfarin and coumarin derivatives, unfractionated heparin, and low–molecular weight heparin to factor-Xa inhibitors, to reduce the risk of suffering life-threatening blood clots and as standard therapy for such ailments as venous thromboembolism. Despite the demonstrated benefits, the powerful medicines also have been associated with 7.2% of all adverse medication events from January 1997 to December 2007, according to the authors.

The new recommendations, endorsed by the Anticoagulation Forum, cover 8 key areas, including process, accountability, integration, and standards of practice, and are based on the best available evidence. They call for leveraging technology such as computerized physician order entry, bar code scanning, and dose range checking, which are techniques that scientific evidence shows decrease medication errors. Even hospitals that are unable to implement such high-tech systems can improve patient health by sending a pharmacist on rounds, which has been shown to slash medication errors by up to 78%.

The guidelines also outline a pathway to multidisciplinary involvement in the anticoagulation management system by tapping the expertise of physicians, nurses, and pharmacists, as well as support personnel. There should be clear lines of command, with defined leaders and a "dedicated champion" who communicates the group's vision, drives accountability, and takes responsibility for day-to-day operation of the system.

What is more, patients should be properly educated about anticoagulant therapies before being discharged from the hospital to ensure that safety gains made in the inpatient setting carry through during transition and after discharge.

"Effective methods of anticoagulation patient education include face-to-face interaction with a trained professional, group training sessions lasting 15-45 minutes, or the use of written materials and other audiovisual resources to review, teach-back, and reinforce the educational process," the authors write.

Measures of success include how well the system works as well as whether the changes improve patients' health. The consensus guidelines call for hospitals to develop methods for tracking, reporting, and responding to such quality indicators.

"Health care organizations are under increasing pressure to develop systems to ensure the safe and effective use of anticoagulants in the inpatient setting," the authors conclude. "This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines developed for outpatients."

Dr. Nutescu has disclosed receiving financial support from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The remaining authors have disclosed no relevant financial relationships.

Ann Pharmacother. 2013;47:714-724. Full text

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