June 5, 2013
New Guidelines Promote Increased Safety for
Inpatient Anticoagulation

Chicago—With nearly 7% of medication errors among inpatients related to anticoagulation use, hospital pharmacists always are searching for ways to employ the medications more safely and effectively.

To provide assistance, a panel of health care experts led by Edith Nutescu, PharmD, clinical pharmacy professor at the University of Illinois at Chicago and director of the Antithrombosis Center there, developed new guidelines. The guidelines also were endorsed by the board of directors of the Anticoagulation Forum.

“Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients,” according to the correspondence published recently in the Annals of Pharmacotherapy. “Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants.”

The guidelines include eight procedures:

• Making sure standardized dosing protocols are available on each patient floor or in the hospital’s electronic medical record or intranet site. The guidelines recommend that technology—computerized physician order entry, bar code scanning, programmable infusion pumps, and examining a patient's range of dosage—be used to reduce medication errors. If technology is not available, Nutescu suggested that including pharmacists on rounds can reduce medication errors by up to 78%.

• Using a multidisciplinary team comprised of physicians, nurses, and pharmacists—and possibly clinicians in quality and safety, laboratory, dietary and information technology disciplines—to care for each patient. That system can provide more expertise if complex therapeutic situations arise, according to the authors.

• Incorporating a reliable system, preferably electronic, to identify and track patients receiving therapy. The information should be integrated with all patient-care resources in the health care institution to ensure accurate and efficient communication of patient information and optimal care, the authors note.

• Using evidence-based standards of practice to ensure the appropriate management of all drug therapies. Nutescu recommended that the clinical use of all treatments be organized on a drug-specific basis using protocols, guidelines, policies, and procedures, and that clinical standards be periodically reviewed and updated to ensure they reflect current evidence and are coordinated with other policies and procedures.

• Providing staff training, ongoing educational development, and documented competency assessment for all multidisciplinary personnel involved in the therapy.

• Using patient education—whether face-to-face interaction, group training sessions or written and audiovisual materials—to achieve better patient outcomes. “Many patients have inadequate knowledge regarding their medication therapy,” Nutescu said. “Improved outcomes have been reported when patients take responsibility for, understand, and adhere to an anticoagulation plan of care.”

• Designing procedures for patients’ safe transition from inpatient to outpatient, or to other settings. Three elements of effective care transitions include: education on blood thinning agents; timely follow-up care with the primary care physician or specialist; and communication between patient and health care provider, according to the guidelines.

• Reviewing how well the system works and what impact it ultimately has on the patient as part of a continuous quality improvement program.

“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 write. “This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients.”

U.S. Pharmacist Social Connect