Anticoagulation Therapy-Understanding the Requirements

What are the key elements organizations need to understand regarding the requirements that apply to anticoagulation therapy ?

Any examples are for illustrative purposes only.

Intent 
The intent of the requirement is to understand that anticoagulant medications are high-risk medications that may cause severe bleeding when not administered or monitored appropriately. Complex dosing requirements, insufficient monitoring, and inconsistent patient compliance can all contribute to adverse drug events or even death. The introduction of direct oral anticoagulants, as alternatives to heparin and warfarin, requires organizations to modify existing protocols and use evidence-based practice guidelines to address the initiation and maintenance of all anticoagulant medications and their associated risk factors. These requirements will promote patient safety and quality of care and are aligned with current recommendations from professional and scientific organizations. 

The new and revised requirements address concepts related to:
  • the use of approved protocols and evidence-based guidelines
  • monitoring
  • patient education
  • family education  
Applicability
The revision of NPSG.03.05.01 applies to several programs.  Hospital (HAP), Critical Access Hospital (CAH), Nursing Care Center (NCC), and Ambulatory Health Care (AHC) accreditation programs. It is important to acknowledge that not all EPs are applicable to all programs. 

Within the AHC program, this NPSG only applies to organizations providing medical services, specifically those that an initiate, manage, and dose anticoagulant medications. NPSG.03.05.01 does not apply to Ambulatory Surgical Centers (ASCs).

Prophylactic Treatment 
Patients taking oral anticoagulation medications need to be managed appropriately during the perioperative period to minimize bleeding risks during surgery. The decision to stop an anticoagulant, use a bridging medication, or to restart an anticoagulant should be based on organization-approved protocols and evidence-based practice guidelines that address the patient’s bleeding risk and renal function, as well as the half-life of the medication.

This NPSG does not apply to routine situations in which short-term prophylactic anticoagulation is used for venous-thromboembolism prevention (VTE) (for example, related to procedures or hospitalization).  However, NPSG.03.05.01 does apply to pharmacologic VTE treatment.

Anticoagulation Therapy
NPSG.03.05.01 only applies to patient's receiving "anticoagulation therapy". Thus, it only applies to patients receiving these drugs for therapeutic purposes, and not for flushes, etc. Subcutaneous heparin is used for therapeutic purposes; therefore, subcutaneous heparin is included.

In addition, this NPSG applies to all classes of anticoagulants with the exception of Antiplatelet Agents-GP IIb/IIIa inhibitors.  The examples provided in the requirements are not an exhaustive list (Heparin, Low Molecular Weight Heparin, Warfarin, Direct Oral Anticoagulants).

Education
Non-adherence with anticoagulation therapy places patients at risk for bleeding and/or clotting that can lead to severe adverse drug events. It is important for patient and family education to emphasize medication adherence, dose and schedule compliance, drug and food interactions, and the need for follow-up appointments and ongoing laboratory tests. It is important to educate patients taking anticoagulants that some foods and medicines can cause adverse interactions that can lead to an increase risk of bleeding while others can lead to an increase risk of developing blood clots.   
 
Last updated on April 28, 2020
Manual: Hospital and Hospital Clinics
Chapter: National Patient Safety Goals NPSG

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