Medication Safety & Anticoagulation Module 3 Medication Safety & Anticoagulation

Part I: Improve the Safety of Using Medications

Labeling of Medications For Perioperative and other Procedural Settings (Includes Bedside Procedures) Label ALL syringes, medicine cups and basins Labeling occurs AFTER the medication is transferred to the syringe of other container NEVER PRELABEL EMPTY SYRINGES OR BASINS Label Includes: Medication Name Strength Quantity Diluent & Volume Preparation Date

Labeling of Medications For Perioperative and other Procedural Settings (Includes Bedside Procedures) Visual and Verbal Verification Required if the container is handed off to another person to administer or at break/shift relief Discard any unlabeled containers immediately!

Multiple Dose Vials MDVs should be dedicated to a single patient whenever possible to reduce the risk of contamination. If multi-dose vials must be used for more than one patient, they should not be kept or accessed in the immediate patient treatment area. For example Insulin vials in the Emergency Department If a MDV enters the immediate care area it is to be dedicated to that patient only

Proper Handling of Multiple Dose Vials (MDVs) Disinfect the vial’s rubber septum before piercing by wiping (and using friction) with a sterile 70% isopropyl alcohol, or other approved antiseptic swab. The septum is allowed to dry before inserting a needle or other device into the vial. No needles are to be left in septum between uses. MDVs should be discarded within 28 days after opening unless otherwise specified by the manufacturer. All vials will be discarded whenever sterility is compromised or questionable, including those placed on a used procedure tray or used during an emergency procedure, even if the vial is unopened/unused.

Fluids That Are Stored in Warmers All fluids put into the warmers require specific dating to ensure stability Label each bag or container with an expiration date that is provided by the manufacturer BBraun allows 28 days from the day that it was placed in the warmer

Look Alike – Sound Alike Medications These are medications that have the same or similar, name, spelling, or physical appearance These are reviewed annually and as necessary by the Pharmacy and Therapeutics Committee and approved by the Medical Executive Committee

Look Alike – Sound Alike Medications New Additions for this year

Part 2: Reduce The Likelihood of Patient Harm Associated with the Use of Anticoagulation Therapy

Anticoagulants ONLY oral unit-dose warfarin, prefilled Fragmin syringes, and premixed heparin drips are used at CHSB.

Use of Approved Protocols CHSB Inpatient Anticoagulation Protocol Available on all units in the Pharmacy Protocol/Formulary Book Includes warfarin (Coumadin), heparin and LMWH (Fragmin) Defines roles of RPh, RN, and Dietician

Warfarin Pharmacy-dosed protocol Rx will monitor and dose all patients MUST check/document INR before 1st dose - Rx will not dispense doses until INR available - RN must document INR on eMAR prior to each dose Care Plan must be initiated & updated - Monitor patient for bleeding - Check INR Educate patient re: bleeding, safety precautions Education must be documented during admission and at discharge

Warfarin Food-Drug Interactions Discharge Instructions Vitamin K in foods Green, leafy vegetables spinach, collard greens, brussel sprouts, broccoli Cranberry juice Discharge Instructions Krames On Demand MUST include: Compliance and the importance of follow-up monitoring Potential for adverse drug reactions and interactions

Heparin NPSG includes therapeutic heparin Heparin flushes, prophylactic doses excluded MUST use premade heparin drips Do NOT mix a heparin drip MUST use the drug library on the infusion pumps when administering

Heparin Protocol Bolus Doses – use 1000 units/ml ONLY NEVER bolus from the infusion bag! Weight-based dosing Monitoring aPTT Baseline every 6 hours after ANY dosage change 6 hours after first therapeutic aPTT every 24 hours after 2 consecutive aPTT CBC with platelets every 3 days

Heparin Protocol Adjusting the rate: aPTT <60: bolus dose and ↑ rate aPTT 60-90: NO ADJUSTMENT aPTT >90: hold drip and/or ↓ rate Recheck the aPTT in 6 hours Document all bolus doses and rate changes on eMAR Each bolus dose is documented on eMAR Any rate changes and each bag change are document on eMAR

Low Molecular Weight Heparin (Fragmin) NPSG includes therapeutic doses Low-dose for DVT prophylaxis excluded Baseline labs required CBC with platelets

Pradaxa (Dabigatran) Baseline laboratory tests: PT/INR SCr Ongoing laboratory tests: SCr every 7 days Pharmacy will adjust dose as needed for renal function

Xarelto (Rivaroxaban) Baseline laboratory tests: CBC SCr Ongoing laboratory tests: SCr every 7 days Should be avoided in patients on dialysis Medication should not be crushed Give with food for better absorption

Eliquis (Apixaban) Baseline laboratory tests: CBC LFTs

Patient Education Only Krames On-Demand will be used Coumadin (warfarin) Heparin Fragmin Pradaxa Xarelto & Eliquis

Thank You