1. National Patient Safety Goal 3E:
Anticoagulation

2. Purpose of National Patient Safety Goals (NPSG):
Promote improvements in patient safety
Highlight problem areas in health care
Describe evidence-based solutions
Focus on system-wide solutions
The purpose of the Joint Commission’s National Patient Safety Goals:
to promote specific improvements in patient safety
highlight problematic areas in health care and describe evidence and expert-based solutions to these problems
focus on system-wide solutions, wherever possible.

3. National Patient Safety Goals
Goals and Requirements are developed by experts
Approved by the JC’s Board in June 2007
Goals and Requirements:
Are developed by experts including those involved in patient safety, system engineers, individuals with hands-on experience in Health Care and experts in related fields (Pharmaceuticals, IT, etc)
Approved by the Joint Commission’s Board in June 20007

4. National Patient Safety Goal 3E: Anticoagulation
Reduce the likelihood of patient harm with the use of anticoagulation (AC) therapy.
Applies to multiple inpatient and outpatient settings
Rationale: Anticoagulation therapy is a high risk treatment
Requirement:
Reduce the likelihood of patient harm associated with the use of anticoagulation (AC) therapy. Applies to:Ambulatory Care, Critical Access Hospital, Home Care, Hospital, Long Term Care, and Office-Based Surgery.Rationale: Anticoagulation is a high risk treatment (complexity of dosing, monitoring of effects, ensuring patient compliance) which commonly leads to Adverse drug events (ADE’s).
Use of standardized practices with patient involvement can reduce the risk of ADE’s.

5. Risks with Anticoagulant Therapy
Anticoagulants listed as one of the top 5 drug Classes with patient safety incidents¹
Reported meds involved in harmful events²:
#3 Heparin, #6 Warfarin, #9 Enoxaparin
Enoxaparin medication related deaths reported to MedMarx in 2005²
Heparin errors typically involve infusion pump and IVdelivery errors³
Cousins D et al. 2006
USP MedMarx data, 2005
Fanikos J. et al. 2004
Look alike products
• Confusion between low molecular weight heparins (LMWHs) and unfractionated heparin (UFH)
• Confusion between insulin and heparin

6. National Patient Safety Goal 3E:
Applies to the use of Heparin, low molecular weight heparins, warfarin and other anticoagulants
One year phase-in period with full implementation by January 1, 2009.
Applies to the use of Heparin (unfractionated), low molecular weight heparin (LMWH), warfarin and other anticoagulants (does not apply to prophylactic doses of heparin and LMWH)
One year phase-in period at 3,6 and 9 months, with full implementation by January 1, 2009.

7. NPSG 3E – Timeline: April 1, 2008 - assigned coordination of NPSG 3E
July 1, implementation work plan & timeline
October 1, 2008, pilot testing in one unit
January 1, process fully implemented
As of April 1, 2008, assigned responsibility for oversight and coordination of NPSG 3E
As of July 1, 2008, an implementation work plan is in place that id’s resources, accountabilities and timeline for full implementation
As of October 1, 2008, pilot testing in at least one clinical unit is under way
As of January 1, 2009, the process is fully implemented across the organization

8. Surveying and Scoring NPSG’s:
Evaluate actual performance
All requirements must be implemented
Compliant or Not Compliant
Failure to comply will result in a “Requirement for Improvement (RFI)”
Surveyors evaluate actual performance, not just intent
All requirements must be implemented
NPSG requirements are Compliant or Not Compliant on a JCAHO survey
Failure to comply with a NPSG Requirement will result in a “Requirement for Improvement (RFI)”

9. NPSG 3E: Anticoagulation
For more information, see the Joint Commission Website:
References:
Cousins D et al Risk assessment of anticoagulation therapy. National Patient Safety Agency. United Kingdom
USP MedMarx data, 2005
Fanikos J. et al. Medication errors associated with anticoagulant therapy in the hospital. Am J Cardiol. 2004; 94:

10. DVT/PE Prophylaxis

11. Procedure related risk DVT/PE
Level of Risk
Calf DVT
Proximal DVT
Clinical PE
Fatal PE
Low 2%
0.4%
0.2%
0.002%
Moderate
10%-20%
2%-4%
1%-2%
0.1%-0.4%
High
20%-40%
4%-8%
0.4%-1%
Very High
40%-80%
4%-10%
0.2%-0.5%
ICSI: Venous Thromboembolism Prophylaxis
Fourth Edition/June 2007

12. Medical Condition Risk DVT
Risk of DVT
General Medical
10%-26% MI
17%-34%
Stroke
11%-75%
CHF
20%-40%
Medical ICU
35%-42%
Chest 2005; 128;

13. Percent of Patients Receiving Appropriate DVT Prophylaxis
75%
66%
54%
Total
50%
45%
Med
38%
38%
Surg
31%
25%
St Joseph’s
Woodwinds
Audit Jan 2008

14. Percent of High Risk Patients 0n Appropriate DVT Prophylaxis
75%
Total
50%
Med
Surg
25%
St Joseph’s
St Joseph’s
Woodwinds
Woodwinds
Audit Jan 2008