2.50
Hdl Handle:
http://hdl.handle.net/10755/182468
Category:
Abstract
Type:
Presentation
Title:
Connecting the Dots for Anticoagulation Patient Safety
Author(s):
Douglas, Jean
Author Details:
Jean Douglas, BS Pharm, PharmD, The Moses Cone Health System, Greensboro, North Carolina, USA, email: jean.douglas@mosescone.com
Abstract:
When looking at the top 10 drugs that cause harm to our patients, heparin is listed as the 3rd highest drug that causes harm and warfarin is the fourth. Over the past 15 years, the usage of anticoagulants has risen dramatically and so have the risks from these therapies. A multidisciplinary six sigma team was formed to reduce the risks being reported in our patients. The goal was to reduce the number of adverse events by 50%. The IHI (Institute for Healthcare Improvement) recommendations and TJC (The Joint Commission) National Patient Safety Goals were used as the basis for documenting risks and implementing strategies to remove these risks from patients. Data was collected from patient care documents,inspections of processes performed, and brainstorming to identify safer procedures were just a few of the tools used. Each team member reviewed the data and an Anticoagulation Scorecard was developed. This scorecard listed the processes that were needed to reduce the identified risks. Team members then began the process of hardwiring changes by making policy changes, practice changes, updating protocols for monitoring and getting buy-in from providers system-wide. At the present time, most of the strategies have been implemented and the number of adverse drug events have been reduced by 17%. Protocol updates and education are underway. An anticoagulation subcommittee composed of all disciplines has been formed to continue the work that has been started. Outcomes measurement has been incorporated into routines and the data has allowed for even more changes to be implemented. Reference: National Patient Safety Goals #3E. The Joint Commission, 2008. www.TJC.com
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2009
Conference Name:
ANCC National Magnet Conference
Conference Host:
American Nurses Credentialing Center
Conference Location:
Louisville, Kentucky, USA
Description:
"Magnet: Inspiring Innovation, Achieving Outcomes" was the theme and "Explore the relationship among leadership, innovation, and nursing practice outcomes" was the goal of the 13th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 1-3 October, 2009 in Louisville, Kentucky, USA.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleConnecting the Dots for Anticoagulation Patient Safetyen_GB
dc.contributor.authorDouglas, Jeanen_US
dc.author.detailsJean Douglas, BS Pharm, PharmD, The Moses Cone Health System, Greensboro, North Carolina, USA, email: jean.douglas@mosescone.comen_US
dc.identifier.urihttp://hdl.handle.net/10755/182468-
dc.description.abstractWhen looking at the top 10 drugs that cause harm to our patients, heparin is listed as the 3rd highest drug that causes harm and warfarin is the fourth. Over the past 15 years, the usage of anticoagulants has risen dramatically and so have the risks from these therapies. A multidisciplinary six sigma team was formed to reduce the risks being reported in our patients. The goal was to reduce the number of adverse events by 50%. The IHI (Institute for Healthcare Improvement) recommendations and TJC (The Joint Commission) National Patient Safety Goals were used as the basis for documenting risks and implementing strategies to remove these risks from patients. Data was collected from patient care documents,inspections of processes performed, and brainstorming to identify safer procedures were just a few of the tools used. Each team member reviewed the data and an Anticoagulation Scorecard was developed. This scorecard listed the processes that were needed to reduce the identified risks. Team members then began the process of hardwiring changes by making policy changes, practice changes, updating protocols for monitoring and getting buy-in from providers system-wide. At the present time, most of the strategies have been implemented and the number of adverse drug events have been reduced by 17%. Protocol updates and education are underway. An anticoagulation subcommittee composed of all disciplines has been formed to continue the work that has been started. Outcomes measurement has been incorporated into routines and the data has allowed for even more changes to be implemented. Reference: National Patient Safety Goals #3E. The Joint Commission, 2008. www.TJC.comen_GB
dc.date.available2011-10-28T15:25:35Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:25:35Z-
dc.conference.date2009en_US
dc.conference.nameANCC National Magnet Conferenceen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.conference.locationLouisville, Kentucky, USAen_US
dc.description"Magnet: Inspiring Innovation, Achieving Outcomes" was the theme and "Explore the relationship among leadership, innovation, and nursing practice outcomes" was the goal of the 13th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 1-3 October, 2009 in Louisville, Kentucky, USA.en_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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