Anticoagulant safety practices call for pharmacist supervision

Key Points

The reports at Hamot of adverse reactions to anticoagulants - strokes, severe bleeding, and death - were similar to accounts coming from other hospitals. This mounting evidence was the basis of the Joint Commission's decision to include in its 2008 Patient Safety Goals the reduction in likelihood of patient harm associated with the use of anticoagulation therapy. The requirement has a one-year phase-in period, which ends on Jan. 1, 2009.

The anticoagulant safety goal, designated 3E, addresses a widely acknowledged patient safety problem in settings that occur in ambulatory care centers, community hospitals, critical-access hospitals, home care, long-term-care facilities, and office-based surgeries. The goal specifies that "anticoagulation commonly leads to adverse drug events due to the complexity of dosing these medications, monitoring their effects, and ensuring patient compliance with outpatient therapy. The use of standardized practices that include patient involvement can reduce the risk of adverse drug events associated with the use of heparin (unfractionated), low molecular weight heparin (LMWH), warfarin, and other anticoagulants."

"Although many hospitals may believe that they have safe systems, I suggest that at every level of an organization, be it a hospital or clinic or physician office or pharmacy, each should be asking the question 'Could it happen here?'," said Frank Federico, RPh, content director of the Institute for Healthcare Improvement's 5 Million Lives Campaign. The campaign has set forth 12 guidelines, or interventions, including the prevention of harm from high-alert medications. "I ask that each [hospital] examine the systems they have in place."

The guidelines stress improving staff communication and access to information, implementing close pharmacy oversight and involvement, and enhancing patient education.

Getting started

At the Northwest Hospital and Medical Center in Seattle, a working group is helping to address the patient safety goal. The group, which meets once a month, includes nurses, doctors, a medical director, and pharmacists. The group's first item of business was to examine existing systems at the hospital and compare those processes with the Joint Commission's goals. "No matter what kind of system you have, there's always room for improvement," said Adam Parcher, the hospital's director of performance improvement and care management and co-chair of the working group. The hospital's employees collaborated, addressing aspects of the safety goal, such as oversight and organization of medications.

The collaboration between nurses, pharmacists, and physicians has been essential to the hospital because so many departments come into contact with patients who are on the medication, Parcher said. Subgroups began studying medical journals and collecting input from colleagues on how to implement best practices in connection with anticoagulant therapy safety concerns. At other hospitals, such as Hamot, staffs have chosen to implement a program quickly, once they feel they have designed the right plan. Finding the best result for a hospital should be determined by the needs of its patients and the benchmarks necessary for success, Parcher said.