28 Development of a systematic approach to reduce the likelihood of patient harm associated with anticoagulant therapy

PurposeCoumadin identified by Institute for Safe Medication Practice as high–risk medication with narrow therapeutic window and high risk of life threatening adverse effectsAnticoagulants identified as one of the top five drug types associated with patient safety incidentsMaintaining INR in recommended therapeutic ranges reducing the incidence of adverse effectsImprove INR–TTR(time in therapeutic range) in patients managed through the Coumadin ClinicComply with nationally established INR goal guidelinesMethodsDevelop routine order setsDefine team roles/expectationsDevelop point–of–care resource optimising access to INR testing.Educational program targeting stakeholdersMonthly meeting auditing patients with goal analysis utilising tracking toolsReview of process/outcome measures.Intervene for change utilising PDSA methodologyPDSA Cycle 1:Retrospective data collection–2008No systematic approach in place/data regarding patient TTR not availableNo structured staff/patient education programPDSA Cycle 2:Implement changesWeb–based software purchasedStructured approach to INR management implemented including stakeholder education programPDSA Cycle 3:Problem monitoring/notifying overdue INR patientsTeam member roles/responsibilities redefined‘Buddy system’ implemented to monitor/notify overdue patientsResultsTTR increased from 66%-2008 to 79%-2013 following implementation of structured policies/programsRe–implementation of education program, revision of policy/procedures TTR increased to 80% Jan–May–2015Optimized point–of–care for INR testing–office finger–stick/remote laboratory testing/home monitoringIncreased INR home monitoringConclusionWith development of systematic approach to high risk patients on anticoagulation therapy, using a web–based software program, significant changes were evident:Improved patient follow–up, communication, decrease in overdue patient numbersIncreased percentage of patients’ within INR rangeApproach driven by the PDSA CQI methodology