The Effect of Digitization on the Safe Management of Anticoagulants

Abstract

Background: Anticoagulants are high-risk medications and are a common cause of adverse events of hospitalised inpatients. The incidence of adverse events involving anticoagulants has remained relatively unchanged over the past two decades, suggesting novel approaches are required to address this persistent issue. Electronic medication management systems (eMMS) offer strategies to help reduce medication incidents and adverse drug events, yet poor system design can introduce new error types. Objective: To evaluate the effect of the introduction of an electronic medical record (EMR) on the quality and safety of therapeutic anticoagulation management. Methods: A retrospective, observational pre/post study was conducted, analysing real-world data across five hospital sites in a single health service. Four metrics were compared one year pre- and one year post-EMR implementation. They included clinician-reported medication incidents, toxic pathology results, hospital-acquired bleeding complications (HACs) and rate of heparin-induced thrombocytopenia. Further sub-analyses of patients experiencing HACs in the post-EMR period, identified key opportunities for intervention to maximise safety and quality of anticoagulation within an eMMS. Results: A significant reduction in HACs was observed in the post-EMR implementation period (mean (SD) =12.1 (4.4)/month, vs. mean (SD) =7.8 (3.5)/month; p=0.01). The categorisation of potential EMR design enhancements found that new automated clinical decision support or improved pathology result integration would be suitable to mitigate future HACs in an eMMS. There was no significant difference in the mean monthly clinician-reported incident rates for anticoagulants or the rate of toxic pathology results in the pre- versus post-EMR implementation period. A 62.5% reduction in the cases of heparin-induced thrombocytopenia were observed in the post-EMR implementation period. Conclusion: The implementation of an EMR improves clinical care outcomes for patients receiving anticoagulation. System design plays a significant role in mitigating the risks associated with anticoagulants and consideration must be given to optimising eMMS.

Editorial: Digital health and prescribing: declare the past, diagnose the present, foretell the future

“…Program director 1 Clinical informatics director and Consultant endocrinologist 4 Full text free online at australianprescriber.tg.org.au EDITORIAL of a clinical analytics product alone. To truly transform practice, clinical decision support must become embedded into clinical workflows and be accepted by busy clinicians.…”

“…The number of patients experiencing a bleed decreased significantly (mean 12.1/month versus 7.8/month, p=0.01). 4 …”

“…The number of patients experiencing a bleed decreased significantly (mean 12.1/month versus 7.8/month, p=0.01). 4 Despite the benefits, digital systems may introduce new types of medication error. For example, selection errors can be made when prescribers choose from a…”

How Safe are Outpatient Electronic Health Records? An Evaluation of Medication-Related Decision Support using the Ambulatory Electronic Health Record Evaluation Tool

“…For example, an early study by Bates et al 7 in inpatients found that medical errors decreased by 86% when a range of CDS features including drug allergy and drug-drug interaction warnings among others were implemented. More recently, a study by Austin et al 8 found that the implementation of an EHR system can improve the clinical outcomes of patients requiring management of their anticoagulant medications. However, the implementation of CDS must be balanced, as having too many alerts can cause alert fatigue.…”