Joint Commission sets anticoagulant therapy safety goal

Key Points

The Joint Commission's recently announced 2008 National Patient Safety Goals include a new requirement to reduce risks associated with anticoagulant therapy. "This directly affects health-system pharmacists, who have implementation responsibilities for this goal," said Peter Angood, M.D., the Joint Commission's VP and chief patient safety officer. "Goals are based on an analysis of our accrued sentinel event database. Then we identify particular problem areas after extensive discussion. The medication safety goals, in particular, are established with pharmacist involvement and expectations."

The anticoagulant safety goal, designated 3E, "addresses a widely acknowledged patient safety problem" in ambulatory care, critical access hospital, home care, hospital, long-term care, and office-based surgery settings. The goal is supposed to be phased in next year. Full implementation is set for Jan. 1, 2009.

The goal explicitly states that "anticoagulation is a high-risk treatment, which 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."

The patient safety risks associated with anticoagulant therapy are significant. In 2002, the U.S. Pharmacopeia MEDMARX program reported that heparin had the highest number of harmful improper medication dosing reports in senior patients. USP data analysis determined that death rates were 11.41% higher with heparin and 6.20% higher with warfarin in hospitals without R.Ph.-managed anticoagulation therapy protocols.

The lack of pharmacist-managed anticoagulation therapy management is also expensive: Hospitals without R.Ph.-managed heparin therapy required 10.05% more patient-days to care for their patients. Those without R.Ph.-managed warfarin therapy required 5.86% more patient-days.

"It is a high-risk treatment because of the complexity of dosing and monitoring. This is a significant issue that requires a collaborative, systemwide effort to successfully address," said Steve Pickette, B.S. Pharm, systems manager for pharmacy clinical services at Providence Health & Services in Seattle. The system has developed best practice protocols for prophylaxis of venous thrombotic events and the appropriate use of anticoagulant therapy through "a rigorous effort that worked backward from our established goal of reduced risk," he said. "We continue to meet every three months to revaluate the practices and our adherence.

"The key to successful compliance with the national patient safety goal is collaborative reevaluation," said Pickette.

More information about the Joint Commission's 2008 National Patient Safety Goals can be found at http://www.jointcommission.org/npsg/.

THE AUTHOR is a writer based in Gettysburg, Pa.