UAB Synopsis, Vol. 27, No. 6, February 18, 2008
By January 1, 2009, The Joint Commission (TJC) expects all hospitals to have implemented steps to reduce the likelihood of patient harm associated with anticoagulation therapy. UAB Hospital Associate Chief of Staff R. Waid Shelton, MD, and Assistant Vice President and Chief Pharmacy Officer Mark W. Todd, PharmD, cochair the UAB and Highlands hospitals’ joint task force that will oversee implementation of this patient safety goal.
“The Joint Commission has published a list of expectations for us to incorporate into daily practice,” Dr. Todd says. “They are actions designed to keep our patients safe, and we will come under serious regulatory scrutiny if we do not comply. These TJC expectations are some of the most comprehensive and aggressive of the patient safety goals.”
Anticoagulation therapy is in widespread use at UAB to control and prevent thromboembolic disorders. “Achieving the proper therapeutic dose is critical, and elderly patients in particular require careful management to achieve sufficient suppression of thrombosis and avoid hemorrhagic complications,” he says.
The task force will review national standards and include medical staff input to develop standardized protocols for anticoagulant therapy. The protocols will be included in IMPACT (Improved Methods of Patient Information Access and Core Clinical Tasks), the new electronic patient information system.
Dr. Todd says the group plans to create an implementation work plan by July 1, pilot test in at least one clinical unit by October 1, and fully implement the plan on January 1, 2009.
Many hospital disciplines affect the efficacy of anticoagulation therapy. Diet clearly affects anticoagulation levels for people on warfarin, and TJC expects the hospitals to educate patients and their families about food and drug interactions.
TJC’s implementation expectations are that the hospital will:
- Plan an anticoagulant management program for individualized care;
- Use only oral unit dose products and pre-mixed infusions, when available;
- Dispense warfarin in accordance with established monitoring procedures;
- Use approved protocols for anticoagulation therapy initiation and maintenance;
- Perform baseline International Normalized Ratio (INR) testing prior to starting therapy and use INR to monitor/adjust therapy;
- Respond according to an established food-drug interaction program developed by dietary services;
- Use programmable infusion pumps for intravenous heparin therapy;
- Develop a policy to address baseline and ongoing lab tests for heparin and low molecular weight heparin therapies;
- Educate staff, patients, and families about anticoagulation therapy, including compliance, diet, and potential for adverse drug reactions and interactions; and
- Evaluate anticoagulation safety practices.
Task Force Members
Dr. Mark W. Todd, PharmD cochair
Dr. R. Waid Shelton, MD, cochair
D. Marcus Montgomery Sr, JD, RN
Nicholas Van Wagoner, MD
John A. Farringer, PharmD
Steven Nasiatka, RN, MSN
James Lyman, MD
Deborah F. Soniat, RN
P. Lauren Rives, BS
T. Aaron Jones, PharmD
James K. Langston, RPh
Nathan Lamb, PharmD
Doris Strother, RN
Penny Phillips, BSN, MBA
Debra R. Cook, RN, MSN
Robert C. Brunner, MD
Marc A. Passman, MD
Sharon Saber, RD, LD