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Standardizing periprocedural anticoagulation management: a stewardship initiative.
Kelly Rudd1, Amanda Winans2, Darren Triller3
1Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, USA. kelly.rudd@okstate.edu.
Journal of Thrombosis and Thrombolysis
|June 26, 2023
Summary
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.
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.
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