The Joint Commission published a new Sentinel Event Alert on July 30th. There is a new class of anticoagulants called direct oral anticoagulants (DOACs). And, they can pose some new issues, like these.
Direct Oral Anticoagulants
In fact, not everyone is familiar with the names of these agents, their mechanism of action and how to reverse bleeding complications.
But, the Sentinel Event Alert contains information that will help bring you up to speed. It includes links to the American College of Cardiology’s 2017 Expert Consensus Decision Pathway on Management of Bleeding and a webinar TJC conducted on this subject.
Sentinel Event Alert Recommendations
In the Sentinel Event Alert, TJC published six specific recommendations. Also, while you are not mandated to implement all six, there should be an appropriate committee or team evaluation of each. Further, make sure this includes decisions on which ones you will put in place and the documented rationales on why you don’t install others.
The six recommendations are as follows:
- Create name awareness for these new agents. This will allow clinicians to recognize the implications when doing patient evaluation and medication reconciliation.
- For each type of anticoagulant use evidence-based protocols and practice guidelines for drug initiation, maintenance and reversal and management of bleeding.
- Have written P+P for baseline and ongoing laboratory monitoring including these newer DOAC’s.
- Include the indication for use on the patient’s prescription, instructions for use and the EMR. This will allow the staff interacting with this patient to reinforce that education.
- Address anticoagulation safety practices and monitor effectiveness, a usual performance improvement approach to enhancing safety.
- Provide detailed drug specific patient education about each of these new agents.
TJC also supplied an informative side bar and a colorful graphic with thematically similar but not identical advice. The sidebar mentions one very practical recommendation about stocking the appropriate blood products and reversal agents, even if you do not have each of these new agents on formulary. It is likely your emergency department will see patients on DOAC’s that you do not have on formulary. But, you may need to provide emergency treatment. The 2017 ACC Expert Consensus Decision Pathway does include a table identifying appropriate reversal agents and treatments.
Patton Healthcare Consulting
Patton Healthcare Consulting provides Joint Commission Compliance Assistance. In addition we offer a full range of pre-survey and post survey services.