Establishing a multidisciplinary taskforce to improve anticoagulation safety at a large health system

Abstract

Purpose To describe the development of a multidisciplinary anticoagulant safety taskforce (ASTF) to address anticoagulation-related issues across the medication-use system. Summary Oral and parenteral anticoagulants have been classified as high-alert medications because of their potential for harm. Errors at the point of prescribing, monitoring, and administering therapy have been noted in safety literature. Our hospital system, which includes 1 academic medical center, 6 community hospitals, and 1 long-term care facility, designed a multidisciplinary ASTF to address anticoagulation-related issues. The ASTF used the 2017 Institute for Safe Medication Practices (ISMP) Medication Safety Self-Assessment for Antithrombotic Therapy as the primary tool for reviewing current practices, performing gap analyses, and identifying our greatest areas of opportunity. The top 8 best practice elements related to anticoagulant use were identified for initial efforts of ASTF activity. Meetings were led by a medication safety pharmacist who reviewed process opportunities and actions to address gaps. The hospital chief quality and patient safety officer and the vice president of quality were the executive sponsors of the ASTF. Key stakeholders such as the medication safety committee chair and the president of the medical staff were instrumental in leading the initiative. Recommendations from the ASTF were reviewed and approved by the system medication safety committee and the system pharmacy and therapeutics committee to support system-wide implementation. The ASTF accomplished more than initially planned within its first year. Error mitigation occurred through policy revisions, order set development and modification, and implementation of practice changes to comply with each best practice. The ISMP antithrombotic self-assessment score improved from 67% to 87%, surpassing the initially targeted score of 75%. To overcome implementation barriers with the electronic health record, we enlisted support from our informatics leadership to leverage information technology. Overall, the success of the taskforce was attributed to the teamwork and leadership of key individuals within the organization. Conclusion Leveraging interest from key stakeholders across multiple disciplines with an established assessment tool was key in developing a productive and successful ASTF. The group came together to evaluate anticoagulant-related issues and implement sustainable changes to decrease anticoagulation error potential.

Practical considerations and consensus opinion for children’s hospital–based inpatient hemostasis and thrombosis (HAT) consultative services: Communication from the ISTH SSC Subcommittee on Pediatric/Neonatal Thrombosis and Hemostasis

“…Engagement of these services, hospital leadership, and information technology teams in the conception and design helps to facilitate the integration of the new service into existing service lines and the health-care organization as a whole. 25 F I G U R E 1 Key concepts for the design and implementation of an inpatient pediatric hemostasis and thrombosis consultative service. ECLS, extracorporeal life support; HAT, hemostasis and thrombosis; VAD, ventricular assist device.…”

“…In addition to hematologists, numerous inpatient services, including intensivists; hospitalists; cardiologists; ECLS/VAD team members; neurologists; physiatrists; neonatologists; nephrologists; hepatologists; hematopathologists; interventional radiologists; as well as general, transplant, and vascular surgeons, could be included in the development process. Engagement of these services, hospital leadership, and information technology teams in the conception and design helps to facilitate the integration of the new service into existing service lines and the health‐care organization as a whole 25 …”

“…The key concepts for the design and implementation of an inpatient HAT service are summarized in Figure 1. Multi‐stakeholder and multi‐disciplinary investment in the system would be considered instrumental in ensuring success 25 . In addition to hematologists, numerous inpatient services, including intensivists; hospitalists; cardiologists; ECLS/VAD team members; neurologists; physiatrists; neonatologists; nephrologists; hepatologists; hematopathologists; interventional radiologists; as well as general, transplant, and vascular surgeons, could be included in the development process.…”

COVID–19 és haemostasis

“…Fontos szem előtt tartani, hogy az egyes ajánlások között az érthető átfedések mellett eltérések is vannak, és nemcsak a farmakológiai megelőzés gyógyszerének megválasztásában, de a dózisban, sőt még az egyes betegcsoportok pontos meghatározásában is. A 3. táblázatot a különféle ajánlásokat, így a Kínai Konszenzus Nyilatkozat (KKNY) [39], az Amerikai Hematológiai Társaság (ASH) [13], a Nemzetközi Th rombosis és Hae mostasis Társaság Tudományos és Standardizációs Bizottsága (ISTH-SSC) [40,45,46], a Global COVID-19 Th rom bosis Collaborative Group (GCTCG) [8], az Anticoagulation Forum (AF) [6], a Health System Anticoagulation Task Force (HSATF) [4], az Amerikai Mellkas Orvosok Kollégiumának állásfoglalása (CHEST) [31], a Vascular Access Society (VAS) [16], az Egészségügyi Világszervezet (WHO) [47] és a német Gesellschaft für Th rombose und Haemostase Forschung (GTH) [21] irányelvei alapján állítottuk össze, kiemelve a különbségeket. Eltérés van például magukban az elnevezésekben is, mert bár a legtöbb társaság/szakértői testület az irányelv (guideline, guidance) szót használja, addig például a VAS vagy az olasz Társaság (Italian Society on Th rombosis and Haemostasis, SISET) [28] "position paper"-t, azaz állásfoglalást adott ki, nagyon helyesen azonban senki nem gondolt a kötelező érvényű előírás (protocol) szó használatára.…”