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Anticoagulation Safety a Hospital Priority for 2008
Mary Amato, Pharm.D., MPH
Health Care Systems that do not have an existing inpatient anticoagulation monitoring program will be required to develop one very soon. The Joint Commission's 2008 list of Hospital National Patient Safety Goals includes a goal (3E) to reduce the likelihood of patient harm with the use of anticoagulation therapy. To achieve compliance with this goal, hospitals are required to meet four deadlines:
April 1, 2008 - Assignment of responsibility for program oversight and coordination of the development, testing, and implementation of the program must be complete.
July 1, 2008 - An implementation work plan that identifies adequate resources, assigned accountabilities and a time line for implementation must be in place.
October 1, 2008 - Pilot testing in at least one clinical unit must be underway
January 1, 2009 - The process must be fully implemented across the organization.
The implementation expectations for this goal are available at:
Expectations include individualized anticoagulation management for each patient receiving anticoagulant therapy, use of unit dose products and pre-mixed infusions delivered via programmable infusion pumps, use of approved protocols for initiation and maintenance of anticoagulation therapy which include the potential for drug interactions and specific to the disease being treated, baseline INRs for all patients receiving warfarin, dietary services for warfarin patients, adequate patient and family education, and evaluation of safety practices.
Planning for this process is currently underway at hospitals. Even those who use existing protocols for anticoagulant dosing or have an anticoagulation monitoring service will need to work to make sure all requirements are met. A publication titled "Managing Anticoagulation Patients in the Hospital: The Inpatient Anticoagulation Service" is a useful resource for those who need some help in planning for complying with this patient safety goal is available from the American Society of Health System Pharmacists at:
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