Drug Topics - November 10, 2008 - (Page H2)

HSE / Cover Story ANTICOAGULANT SAFETY The reports at Hamot of adverse reactions to anticoagulants — strokes, severe bleeding, and death — were similar to accounts com- anticoagulant medications can prevent ing from other hospitals. This mount- errors arising from misuse of anticoaguing evidence was the basis of the Joint lants by implementing speciﬁc risk reCommission’s decision to include in its duction strategies, the alert stated. The 2008 Patient Safety Goals the reduction Joint Commission recommended risk in likelihood of patient harm associated strategies be implemented by all staff with the use of anticoagulation thera- members who manage anticoagulants. py. The requirement has a one-year “Although many hospitals may bephase-in period, which lieve that they have safe ends on Jan. 1, 2009. systems, I suggest that at The anticoagulant every level of an organisafety goal, designated zation, be it a hospital or POWER POINTS 3E, addresses a widely acclinic or physician office knowledged patient safety or pharmacy, each should New safety requirement goal problem in settings that be asking the question has one-year occur in ambulatory care ‘Could it happen here?’,” phase-in period. centers, community hossaid Frank Federico, RPh, pitals, critical-access hoscontent director of the Joint Commission pitals, home care, longInstitute for Healthcare issued a sentinel term-care facilities, and Improvement’s 5 Milevent alert in September. ofﬁce-based surgeries. The lion Lives Campaign. The goal speciﬁes that “anticocampaign has set forth The new goal agulation commonly leads 12 guidelines, or interacknowledges to adverse drug events due ventions, including the widely-known safety to the complexity of dosing prevention of harm from problems. these medications, monihigh-alert medications. “I toring their effects, and ask that each [hospital] ensuring patient compliexamine the systems they ance with outpatient therapy. The use have in place.” of standardized practices that include The guidelines stress improving staff patient involvement can reduce the communication and access to informarisk of adverse drug events associated tion, implementing close pharmacy with the use of heparin (unfraction- oversight and involvement, and enhancated), low molecular weight heparin ing patient education. (LMWH), warfarin, and other anticoagulants.” Getting started The Joint Commission also issued a At the Northwest Hospital and Medisentinel event alert on Sept. 24, 2008, cal Center in Seattle, a working group titled “Preventing errors relating to is helping to address the patient safety commonly used anticoagulants,” which goal. The group, which meets once reviewed common errors dealing with a month, includes nurses, doctors, a anticoagulant medications and strate- medical director, and pharmacists. The gies for risk reduction. Healthcare or- group’s ﬁrst item of business was to exganizations that dispense or administer amine existing systems at the hospital “I think every hospital needs to think about how they teach their staff about the dangers as well as the beneﬁts of anticoagulation so that it’s not taken lightly, because these are drugs that can clearly result in harm.”— Frank A. Frederico, RPh 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. Creating a plan Mt. Sinai Medical Center in New York also quickly initiated a search for better ways to organize warfarin use and reduce the possibility of an incorrect dose. The hospital asked its information technology department to create an online component that would help doctors determine speciﬁc target ranges for each patient. The link displays published guidelines for a patient, explained Gina Caliendo, PharmD, Mt. Sinai’s Associate Director of Clinical Pharmacy Services. As W W W.D R U GTO P I C S .C O M H2 DRUG TOPICS N OV. 10, 2008

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Drug Topics - November 10, 2008 Contents Up Front Up Front in Depth Letters Rx Care Government Community Practice First Responders Clinical Practice Self-Care FDA Safety Page Weighing the Complications of Obesity New Products Viewpoint

Drug Topics - November 10, 2008

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