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Standardizing periprocedural anticoagulation management: a stewardship initiative.

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Managing anticoagulation peri-procedurally is challenging. This study implemented a standardized electronic health record (EHR) process, improving patient safety and reducing adverse events for anticoagulated patients undergoing procedures.

Keywords:
Adverse eventsAnticoagulantClinical Decision Support SystemsMedication safetyPeri-proceduralStewardship

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Area of Science:

  • Cardiology
  • Pharmacology
  • Health Informatics

Background:

  • Peri-procedural interruption of anticoagulation increases bleeding and thrombosis risks.
  • Managing anticoagulated patients during procedures presents significant clinical challenges.
  • Optimizing patient safety and efficacy requires enhanced peri-procedural anticoagulation care.

Purpose of the Study:

  • To create a standardized, efficient, and comprehensive peri-procedural anticoagulation management process within the electronic health record (EHR).

Main Methods:

  • Adapted IPRO-MAPPP clinical decision support logic into a nurse-managed protocol for elective peri-procedural anticoagulation.
  • Implemented a phased approach, with a second phase including Anticoagulation Management Service oversight for warfarin and bridging.

Main Results:

  • 30-day hospital or emergency department admissions remained at or below 1% for the surgical patient population.
  • Outcomes were below published national standards during both implementation phases.
  • No emergent anticoagulation reversal agent use was linked to peri-procedural care.

Conclusions:

  • Phased implementation of this Anticoagulation Stewardship initiative demonstrates high-quality, low-variation care in elective peri-procedural anticoagulation.
  • Integrating EHR-housed clinical decision support and effective communication ensures stability and sustainability.
  • This approach optimizes patient outcomes through high-quality peri-procedural anticoagulation management.