Evaluation of a continuous quality improvement program in anticoagulant therapy

Cantin, Ariane; Lahaie, Alexandre; Odobasic, Bojan; Tremblay, Marie-Philip; Wazzan, Dana; Caron, S.; Leblanc, Caroline; Martineau, Josée; Lalonde, Lyne

doi:10.1177/1715163516671334

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Overall participation and satisfaction rates were relatively high. As reported in a related article, community pharmacists appreciated the ACO programme and reported an increased sense of personal effectiveness using cognitive behavioural learning determinants . Finally, over a 6‐month period, improvements in the quality of clinical practices and pharmacists’ knowledge were observed, suggesting the programme may be effective in improving clinical practices.…”

Section: Discussionmentioning

confidence: 99%

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Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

et al. 2018

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Section: Discussionmentioning

confidence: 99%

“…Some components of the ACO programme were not frequently used. For instance, pharmacists did not actively participate in the discussion forum, although consultation was high . This component might be the least relevant to community pharmacists’ needs and expectations.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

et al. 2018

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How reliable is perioperative anticoagulant management? Determining guideline compliance and practice variation by a retrospective patient record review

et al. 2019

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ObjectivesSurgery in patients on anticoagulants requires careful monitoring and risk assessment to prevent harm. Required interruptions of anticoagulants and deciding whether to use bridging anticoagulation add further complexity. This process, known as perioperative anticoagulant management (PAM), is optimised by using guidelines. Optimal PAM prevents thromboembolic and bleeding complications. The purpose of this study was to assess the reliability of PAM practice in Dutch hospitals. Additionally, the variations between hospitals and different bridging dosages were studied.DesignA multicentre retrospective patient record review.Setting and participantsRecords from 268 patients using vitamin-K antagonist (VKA) anticoagulants who underwent surgery in a representative random sample of 13 Dutch hospitals were reviewed, 259 were analysed.Primary and secondary outcome measuresOur primary outcome measure was the reliability of PAM expressed as the percentage of patients receiving guideline compliant care. Seven PAM steps were included. Secondary outcome measures included different bridging dosages used and an analysis of practice variation on the hospital level.ResultsPreoperative compliance was lowest for timely VKA interruptions: 58.8% (95% CI 50.0% to 67.7%) and highest for timely preoperative assessments: 81% (95% CI 75.0% to 86.5%). Postoperative compliance was lowest for timely VKA restarts: 39.9% (95% CI 33.1% to 46.7%) and highest for the decision to apply bridging: 68.5% (95% CI 62.3% to 74.8%). Variation in compliance between hospitals was present for the timely preoperative assessment (range 41%–100%), international normalised ratio testing (range 21%–94%) and postoperative bridging (range 20%–88%). Subtherapeutic bridging was used in 50.5% of patients and increased with patients’ weight.ConclusionsUnsatisfying compliance for most PAM steps, reflect suboptimal reliability of PAM. Furthermore, the hospital performance varied. This increases the risk for adverse events, warranting quality improvement. The development of process measures can help but will be complicated by the availability of a strong supporting evidence base and integrated care delivery regarding PAM.

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Evaluation of a continuous quality improvement program in anticoagulant therapy

Abstract: ORIGINAL RESEARCH * PEER-REvIEwEd 671334C PHXXX10.1177/1715163516671334C P J / R P CC P J / R P C

Cited by 2 publications

References 22 publications

Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

How reliable is perioperative anticoagulant management? Determining guideline compliance and practice variation by a retrospective patient record review

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