Delivery of Optimized Inpatient Anticoagulation Therapy: Consensus Statement from the Anticoagulation Forum

Abstract

Objective To provide recommendations for optimized anticoagulant therapy in the inpatient setting and outline broad elements that need to be in place for effective management of anticoagulant therapy in hospitalized patients. The guidelines are designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. Study Selection and Data Extraction Because of this document’s scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable. In these cases, recommendations represent consensus opinion of all authors and are endorsed by the Board of Directors of The Anticoagulation Forum, a organization dedicated to optimizing anticoagulation care. The Board is composed of physicians, pharmacists, and nurses with demonstrated expertise and experience in the management of patients receiving anticoagulation therapy. Data Synthesis Recommendations for delivering optimized inpatient anticoagulation therapy were developed collaboratively by the authors and are summarized in eight key areas: (1) process, (2) accountability, (3) integration, (4) standards of practice, (5) provider education and competency, (6) patient education (7) care transitions, (8) outcomes. Recommendations are intended to inform the development of coordinated care systems containing elements with demonstrated benefit in improvement of anticoagulation therapy outcomes. Recommendations for delivering optimized inpatient anticoagulation therapy are intended to apply to all clinicians involved in the care of hospitalized patients receiving anticoagulation therapy. Conclusions Anticoagulants are high-risk medications associated with a significant rate of medication errors among hospitalized patients. Several national organizations have introduced initiatives to reduce the likelihood of patient harm associated with the use of anticoagulants. Healthcare organizations are under increasing pressure to develop systems to assure the safe and effective use of anticoagulants in the inpatient setting. This document provides consensus guidelines for anticoagulant therapy in the inpatient setting and serves as a companion document to prior guidelines relevant for outpatients.

Medication utilization evaluation of dabigatran and rivaroxaban within a large, multi-center health system

“…15 Patient education in the hospital setting is vital to ensure appropriate utilization and understanding of these medications. Educational instructions may include proper medication administration, compliance, monitoring, drug and food interactions, and potential adverse reactions from anticoagulant therapy.…”

Regulatory, legislative, and policy updates with anticoagulant use

“…7) [7]. TJC, the Institute for Safe Medication Practices (ISMP), NQF, and the Anticoagulation Forum have identified goals and strategies for improving anticoagulation management in the inpatient setting [34][35][36][37]. The National Quality Strategy (NQS) has focused on improving provider EHR tools to access medication profiles and laboratory results through a real-time pharmacy-laboratory linked system as well as the centralized exchange of patient data between facilities [7].…”

Rivaroxaban: Practical Considerations for Ensuring Safety and Efficacy

“…Therefore, to minimize the risk of adverse outcomes and related hospitalizations, appropriate care transition plans should be in place for patients treated with rivaroxaban who are transitioned from one health care setting to another. Fundamental elements that have to be incorporated into the care transition plans include education, access to the drug on discharge, follow‐up care, and communication . Specific education on rivaroxaban should be provided to the patient and family or caregivers.…”

“…Fundamental elements that have to be incorporated into the care transition plans include education, access to the drug on discharge, follow-up care, and communication. 88 Specific education on rivaroxaban should be provided to the patient and family or caregivers. In addition, the staff involved in the patient's care should also be educated and demonstrate competency in knowledge and management of anticoagulation therapy including rivaroxaban.…”