achieving national patient safety goals in an …national patient safety goals (npsg) • npsgs were...
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Achieving National Patient Safety Goals in an Ambulatory Anticoagulation
Management Setting
Peter Collins, PharmD, RPh, CACP
Advanced Clinical Practice Pharmacist
Anticoagulation Management Service
Brigham and Women’s Hospital
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Objectives
• Define the National Patient Safety Goals
• Identify which specific goals apply to an ambulatory anticoagulation management setting
• Demonstrate how DAWN AC can be utilized to achieve these goals and increase both patient safety and quality of care
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National Patient Safety Goals (NPSG)• NPSGs were created to help accredited organizations address specific areas
of concern regarding patient safety
• Established in 2002 by The Joint Commission• Created by panel composed of nurses, physicians, pharmacists, risk managers, and
more
• First set of NPSGs were effective starting January 1, 2003 and are updated annually
• Benefits of accreditation include:• Reduction in liability insurance costs
• Authorization of Medicare certification
• Recognition by insurers
• Mandatory regulatory requirement in select states
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National Patient Safety Goals (NPSG)
https://www.slideshare.net/nillyshams/patient-safety-made-easy
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NPSG.03.05.01
Reduce the likelihood of patient harm associated with the use of
anticoagulant therapy
• Class of medication most likely to cause harm due to complex dosing, requirement of laboratory monitoring, and inconsistent patient compliance
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Protocols & Guidelines
• Medication Management
• Choosing Between Oral Anticoagulation Agents
• DOAC Clinic Management Plan
• Warfarin / DOAC Drug-Drug Interaction Guideline
• Peri-Procedural Anticoagulation Management Protocol
• Reversal of anticoagulation and management of bleeding events
• Anticoagulation Reversal Guidelines
• Critically High / Low INR Protocol
• Vitamin K Drug Administration Guidelines
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How can DAWN AC help?
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NPSG.03.05.01: Elements of PerformanceNPSG.03.05.01: Elements of PerformanceNPSG.03.05.01: Elements of PerformanceNPSG.03.05.01: Elements of Performance
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3 & 5. Before starting a patient on a direct oral anticoagulant (DOAC) or warfarin, follow evidence-based practice guidelines regarding the need for any baseline and ongoing laboratory tests that may be required to monitor the patient on anticoagulation therapy.
• All patients require coagulation labs to be documented in DAWN AC
• Warfarin and DOAC patients have standardized follow up protocols to ensure quality care is provided
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DAWN AC: Warfarin Patients
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DAWN AC: DOAC Patients
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DOAC Management Plan
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DOAC Management Plan
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DAWN AC: DOAC Candidate Questionnaires
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DAWN AC: DOAC Follow Up Questionnaires
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DAWN AC: DOAC Additional Notes
Hospital Visits Lab Values Communication
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DAWN AC: DOAC Patients
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6. The organization has a process developed using evidence-based practice guidelines for perioperative management of all patients on oral anticoagulants. The process addresses the following:
• Situations in which the anticoagulant is stopped prior to the procedure
• Timing for stopping the anticoagulant and length of time it should be held
• Timing and dosing for restarting the anticoagulant
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Peri-Procedural Management
• All peri-procedural anticoagulation
plans must be documented in DAWN
AC (via Procedures tab) and EPIC
• BWH AMS prepares more than 120
procedure plans per month
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7. Provide education to patients and families specific to the anticoagulant medication prescribed, including the following:
• Adherence to medication dosing and schedule
• Importance of follow-up laboratory testing (if applicable) and physician appointments
• Potential drug-drug and drug-food interactions
• The potential for adverse drug reactions
8. The organization has a written policy that addresses anticoagulation safety practices, including the following:
• The identification and reporting of adverse drug events, including outcomes and actions taken
• Evaluation of the effectiveness of those actions in a time frame determined by the organization
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Documentation of Education
Quick Codes
.nped New Patient Education
.ed10 Patient Education
.in10 Intervention
• Quick Code system within DAWN AC can be used to document
patient education, pharmacist interventions, and adverse drug
events
• Pharmacist impact can be quantified using reporting features
that analyze quick code usage
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Documentation of Education
• Functionality to document education of DOAC patients is built into both types of questionnaires
• Clinical note is uploaded to our centralized EMR after each warfarin or DOAC patient is initially enrolled
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Drug-Drug Interactions
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Documentation of Adverse Events
Quick Codes
.ad10 Adverse Drug Event
• All adverse events are documented in the Treatment Notes
(warfarin patients) and in the Events tab (warfarin / DOAC
patients)
• Event reporting allows a comprehensive look at the event
rates in a different populations
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Conclusions
• National Patient Safety Goals assist organizations by identifying areas that require extra attention in order to reduce adverse outcomes
• Anticoagulation Management Services need to have protocols and systems in place to ensure safe and effective management of patients
• DAWN AC has many features that are able to assist providers in fulfilling National Patient Safety Goals and thus increasing the quality of care patients receive
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Questions?