Reducing anticoagulant medication adverse vents and avoidable patient harm.
BACKGROUND
The conventional standard of care for many patients at Saint Joseph HealthCare, a three-hospital system in Kentucky, includes the use of anticoagulant therapy. In view of the morbidity and mortality associated with anticoagulation-related complications, the prevention of bleeding and thrombotic adverse drug events was identified as a primary process improvement initiative.


METHODS
Following establishment of an interdisciplinary team, formal evaluations of anticoagulant-use practices and associated patient outcomes occurred via several mechanisms. A variety of process improvement activities were conducted, including the creation of a pharmacist-managed hospital anticoagulant therapy service. A pharmacist consult service for the medical staff provided initiation, management, and monitoring of anticoagulation, including bridge therapy and reversal if necessary.


RESULTS
The rate of thrombotic events decreased from 4.6% in 2004 to 3.9% in 2006 and further decreased to 0.0% for patients managed by collaborative physician and pharmacist practice. Hospitalwide bleeding and thrombotic reactions decreased from a monthly average of 11.52 events per 1,000 anticoagulant doses dispensed in 2004 to 0.07 in 2006. A cost-benefit evaluation indicated an annual savings of up to $9.8 million in avoidable costs.


CONCLUSIONS
In this interdisciplinary project, anticoagulant safety was integrated throughout the institution, and a variety of medication safety systems were successfully employed.
Jennings
Heath R
HR
Department of Pharmacy Services, Saint Joseph HealthCare, Lexington, Kentucky, USA.
Miller
Eric C
EC
Williams
Tina S
TS
Tichenor
Sherry S
SS
Woods
Eugene A
EA
D016907:Adverse Drug Reaction Reporting Systems / Q000458:organization & administration*; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001363:Awards and Prizes; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D007629:Kentucky; D008508:Medication Errors / Q000517:prevention & control*; D009096:Multi-Institutional Systems; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration; D017751:Safety Management / Q000379:methods*; D013927:Thrombosis / Q000139:chemically induced / Q000517:prevention & control
D000925:Anticoagulants