PB0993 - Anticoagulation stewardship: The new standard of care in anticoagulant safety. Experiences from a large, tertiary, multicentre health service.

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Emma J. Leitinger, MBBS BMedSci FRACP FRCPA

Haematologist, PhD Candidate
Monash Health
Melbourne, Victoria, Australia

Co-Author(s)

NR

Nadishani Ratnayake

Anticoagulation Stewardship (ACS) Pharmacist (Lead)
Monash Health
Melbourne, Victoria, Australia
ST

Simone Taylor

Anticoagulation Stewardship Pharmacist
Monash Health
Melbourne, Victoria, Australia
NL

Nicholas Ling

Anticoagulation Stewardship Pharmacist
Monash Health
Melbourne, Victoria, Australia
JS

Jasmine Singh

Haematologist
Monash Health
Melbourne, Victoria, Australia
Hiu Lam Agnes Yuen

Consultant Haematologist
Monash Medical Centre
Clayton, Victoria, Australia
KH

Kay Htun

Haematologist
Monash Health
Melbourne, Victoria, Australia
Charithani Keragala, MBBS (Hons), PhD, FRACP, FRCPA

Haematologist and ECR
Monash University
Melbourne, Victoria, Australia
ZH

Zahraa Hamad

Pharmacy student
Monash University
Melbourne, Victoria, Australia
EC

Emily Chen

Pharmacy student
Monash University
Melbourne, Victoria, Australia
KW

Katherine Wilson

Senior Analyst, Business Intelligence
Monash Health
Melbourne, Victoria, Australia
BK

Ben Kuppe

Director of Business Intelligence
Monash Health
Melbourne, Victoria, Australia
TD

Tania Duncan

Projects and Data Governance Lead, Business Intelligence
Monash Health
Melbourne, Victoria, Australia
MS

Mark Sheppard

Senior Pharmacist
Monash Health
Melbourne, Victoria, Australia
SC

Sanjeev Chunilal

Director, Laboratory Haematology
Monash Health
Clayton, Victoria, Australia
SB

Susan Brown

Haematologist, Acting Head of Unit
Monash Health
Melbourne, Victoria, Australia

Background: Anticoagulants are high-risk therapies accounting for 8.3% of all inpatient medication errors, and are associated with increased 30 day mortality and hospital expenditure. Following several sentinel events, we designed and implemented an anticoagulation stewardship (ACS) service at Monash Health, a large tertiary hospital with over 1,800 inpatient beds across 6 sites and 4 emergency departments, in Melbourne, Australia.

Aims: Describe the design, implementation and activities of an ACS program in our hospital network.

Methods: Descriptive summary of service design, structure, implementation, and overview of activities from 8th November 2022 to 31st December 2023.

The Hospital Board approved funding for 2 pharmacists, a clinical nurse consultant, and haematologist oversight. The ACS committee comprises key stakeholders including Department heads, Pharmacy, Quality and Safety officers, and Operations managers. Our ACS model differs by focussing on incorporating electronic records to proactively identify patients and provide remote oversight across multiple campuses.
The service was established in November 2022, and operates Monday to Friday, 8:30am-5pm. Patients are identified either by direct referral, or through an electronic “dashboard”, developed in conjunction with Business Intelligence (BI) (see abstract 1734574).

Results:

Design: The program targets high-risk patient groups to proactively intervene and reduce harm. It has a strong focus on collaboration and quality improvement through review and development of protocols and policies (Figure 1).
Structure: Figure 2 outlines the service structure, with oversight by the Quality Board and ACS committee. The service team support patient-facing staff through referrals and daily virtual dashboard rounds.
Implementation: The ACS has recommended 2335 interventions relating to monitoring or changing anticoagulant therapy to maximise safety. 1688 stemmed from direct referral, and 647 were proactively identified from the electronic dashboard.

Conclusion(s): Monash Health has designed and implemented a multidisciplinary anticoagulation stewardship program. Integrating electronic medical systems and prescribing data has allowed efficient resource allocation to maximise service delivery.