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New Core Elements of Anticoagulation Stewardship Programs Guide

We are excited to announce the release of our new FDA-funded report: Core Elements of Anticoagulation Stewardship Programs, which outlines systemic protocols designed to improve the safety and quality of patient care and reduce adverse drug events associated with anticoagulants. Anticoagulants are proven life-saving therapies for individuals with cardiac and vascular disorders, however, despite the positive health outcomes of anticoagulants, there are known risks associated with anticoagulant medication. Therefore, improving the systematic management of anticoagulants within and across care settings must be a key priority.

Anticoagulation Stewardship

Download our new FDA-funded report, Core Elements of Anticoagulation Stewardship Programs. This Anticoagulation Stewardship Programs guide is intended to be applicable to all care settings and all anticoagulation patient populations. By implementing effective, evidence-based system improvements to address high-priority concerns, all care settings can optimize the quality and safety of anticoagulant use and overall patient management.

THE GOAL

Coordinated, efficient, sustainable system-level initiatives designed to achieve optimal anticoagulant-related health outcomes and minimize avoidable adverse drug events.


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Improving the systematic management of anticoagulants within and across care settings must be a key priority.

7 Core Elements of Anticoagulation Stewardship Programs

  • Secure Administrative Leadership Commitment: Dedicating necessary human, financial, and technology resources
  • Establish Professional Accountability and Expertise: Appointing a single leader responsible for program outcomes, supported by at least one clinician with expertise in anticoagulation management
  • Engage Multidisciplinary Support: Involving key specialists and disciplines to obtain perspective from all domains of the care delivery system
  • Perform Data Collection, Tracking, and Analysis: Defining the population, objectively evaluating performance, and guiding decision-making
  • Implement Systematic Care: Implementing sustainable, efficient, evidence-based action(s) at the system level to assure the safety and quality of anticoagulation management
  • Facilitate Transitions of Care: Creating systems to optimize communication and ensure safe transitions between care settings
  • Advance Education, Comprehension, and Competency: Assuring that clinicians, patients, and others have the knowledge and skills necessary to optimize outcomes


Checklist

The Core Elements of Anticoagulation Stewardship Programs guide includes a supporting Checklist as a tool for health systems to evaluate their current environment and identify areas warranting action. Healthcare teams can use this checklist to determine if essential support, resources, and initiatives are in place for optimal management of patients on anticoagulation medications. As each healthcare setting is unique, implementation of checklist elements may need to be customized, based on infrastructure and access to resources.

THE CHECKLIST

Determine if support, resources, and initiatives are in place for optimal management of patients on anticoagulation medications.


Download the Checklist


Coordinated, efficient, system-level initiatives designed to achieve optimal anticoagulant-related health outcomes and minimize avoidable adverse drug events.



Administrative Oversight Gap Analysis

A Gap Analysis was conducted by an expert panel of healthcare professionals to identify key administrative oversight resources applicable to hospital and skilled nursing facility settings and to oversee a systematic and iterative process to identify, categorize, and prioritize perceived gaps relating to anticoagulation management.

The Gap Analysis identified 74 perceived weaknesses in the current oversight modalities that the Anticoagulation Forum believes increase the risk of patient harm associated with anticoagulant use or impede the evaluation and measurement of the quality and safety of related care processes.

GAP ANALYSIS

Identifies gaps and offers recommendations to improve regulations and quality measures to increase safety and the quality of care in hospital and skilled nursing facilities.


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Anticoagulants are unique among commonly prescribed drug classes and require additional safeguards, processes, and practices to minimize serious and life-threatening adverse events.



Regulatory Efforts Supporting Anticoagulation Stewardship

The Department of Health and Human Services’ National Action Plan for Adverse Drug Event [ADE] Prevention reports that anticoagulation therapy is underutilized in the patient populations for whom it is most beneficial. It further encourages that future public health initiatives will need to foster a comprehensive approach that addresses both anticoagulant effectiveness and safety.

U.S. Department of Health and Human Services National Action Plan for Adverse Drug Event Prevention


Anticoagulants are one of three top drug classes targeted for enhanced national surveillance and prevention efforts.


Longstanding national patient safety goal for anticoagulant therapy updated to include proper management goals for DOACs.





Federal partners should lead efforts to promote the concept of “anticoagulation stewardship” to reduce anticoagulant ADE burden.



The ADE Action Plan refers to anticoagulation stewardship as a multidisciplinary, coordinated, and systemic approach to care, analogous to the successful approach used to improve antibiotic use in patient settings.

Also noteworthy is the Joint Commission’s decision to revise National Patient Safety Goal [NPSG] 03.05.01 in response to a rise in adverse drug events associated with direct oral anticoagulants [DOACs], effective July 1, 2019.

The Joint Commission believes that the eight new elements of performance, expected to apply to all Joint Commission-accredited hospitals, critical access hospitals, nursing care centers, and medical centers [accredited under the ambulatory health care program], may help reverse this trend.


Summary