In the November 2018 issue of The Joint Commission Journal on Quality and Patient Safety, results of an IPRO-convened task force of The New York State Anticoagulation Coalition were published. The article details a list of Requisite Data Elements (RDEs) to adequately manage the anticoagulants of patients new to care from a previous setting.

Anticoagulants, medications that keep the blood from clotting, are heavily prescribed and effective but have been identified as major contributors to Adverse Drug Events (ADEs). Because many serious ADEs are thought to be preventable through improvements in care delivery, proper anticoagulant management is important during the continuum of care across the entire health care system, including during care transitions.

The article, “Defining Minimum Necessary Anticoagulation-Related Communication at Discharge: Consensus of the Care Transitions Task Force of the New York State Anticoagulation Coalition,” by Darren Triller, PharmD, president and CEO, WellScriptEd Consulting, Inc., Delmar, New York, and co-authors, outlines 15 RDEs on which the task force reached consensus for anticoagulation communication at discharge (the ACDC List):

  • Anticoagulant(s) currently used
  • Indication(s) for anticoagulation therapy
  • Documentation describing whether the patient is new to anticoagulation therapy or a previous user
  • If a patient is new to anticoagulation therapy, the start date of the anticoagulation
  • Documentation indicating whether treatment is intended to be acute (short term) or chronic (long term)
  • If any acute indications, the intended duration of therapy
  • Date, time, route, dose and strength of last two doses given
  • Date, time and magnitude of next dose due
  • Most recent assessment of renal function (within past 30 days, with date and results)
  • Documentation of the provision of patient education materials about the anticoagulant
  • Assessment of patient/caregiver understanding of their anticoagulant regimen
  • If transitioning to a non-institutionalized setting, expectations for who was responsible for ongoing anticoagulation management
  • If prescribed warfarin, the target International Normalized Ratio (INR) or INR range
  • If prescribed warfarin, a minimum of 2–3 consecutive INR lab results (with dates and results)
  • If prescribed warfarin, the date the next INR is due

“Effective solutions to improve anticoagulation safety and effectiveness will be complex, but the ACDC List is an important contribution to improving anticoagulation management during one of the most vulnerable periods of patient care,” notes Nadine Shehab, PharmD, MPH, senior scientist, Medication Safety Program, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, and co-authors, in an accompanying editorial. The authors recommend additional research to validate the ACDC and evaluate the impact of related interventions on patient outcomes.

The Great Plains QIN is partnering with providers, pharmacists and stakeholders in the region to reduce and monitor ADE rates including those associated with anticoagulants. Tools and resources are available on the Great Plains QIN website.