Anticoagulants – medications that keep blood from clotting – have been named the No. 2 top medications involved in error incidents causing death or serious harm, reports The Joint Commission. While direct oral anticoagulants (DOACs) offer ease of use to patients, stopping bleeding events in patients on DOACs is more complicated, requiring different strategies than those for patients on warfarin (Coumadin) and heparin.
In response to an increase in adverse events related to these widely prescribed medications, The Joint Commission has published a new Sentinel Event Alert on managing the risks of DOACs. The alert provides guidance on safe use and management of DOACs to all medical practitioners and healthcare organization leaders, particularly chief medical officers, pharmacists, emergency department clinicians, and quality and safety officers.
The alert stresses the importance of understanding risks, benefits, side effects and potential antidotes or reversal agents for all kinds of anticoagulants, and communicating this information as appropriate to patients, their families and caregivers. According to the alert, to avoid wrong interventions for patients taking DOACs, clinicians should be aware of how:
· DOACs present different risks than warfarin and heparin and have different reversal mechanisms.
· A reversal mechanism that works for one DOAC may not work for another.
· Perioperative assessment and communication are critical to assess bleeding risk.
Safety actions outlined in the alert encourage healthcare organizations to:
· Create name awareness for the various kinds of DOACs – particularly among pharmacists, emergency department clinicians and providers who may be called upon to rapidly reverse life-threatening bleeding.
· Use evidence-based protocols and practice guidelines for drug initiation and maintenance, reversal of anticoagulation, and management of bleeding events and perioperative management.
· Maintain a written policy on the need for baseline and ongoing laboratory tests to monitor and adjust anticoagulant therapy.
· Include particular DOAC’s indications for use in the patient’s instructions, prescription and electronic medical record.
· Address anticoagulation safety practices by taking actions to improve and measure them, as well as to establish a process to identify, respond to and report adverse drug events.
· Provide education to patients, their families and caregivers specific to the anticoagulant prescribed.
The Joint Commission revised its National Patient Safety Goal (NPSG) on anticoagulation, effective July 1, 2019 for hospitals, critical access hospitals, nursing care centers and ambulatory care organizations that initiate, manage and adjust dosage for anticoagulation medications. The NPSG was revised to assist these organizations in designing systems of care to prevent quality and safety issues related to DOAC prescribing, monitoring and treatment of severe bleeding.