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. 2022 Aug;13(4):845-856.
doi: 10.1055/a-1910-4339. Epub 2022 Jul 27.

The Effect of Digitization on the Safe Management of Anticoagulants

Jodie A Austin  1 , Michael A Barras  2   3 , Leanna S Woods  1   4 , Clair M Sullivan  1   5
Affiliations

The Effect of Digitization on the Safe Management of Anticoagulants

Jodie A Austin et al. Appl Clin Inform. 2022 Aug.

Abstract

Background: Anticoagulants are high-risk medications and are a common cause of adverse events of hospitalized inpatients. The incidence of adverse events involving anticoagulants has remained relatively unchanged over the past two decades, suggesting that novel approaches are required to address this persistent issue. Electronic medication management systems (eMMSs) offer strategies to help reduce medication incidents and adverse drug events, yet poor system design can introduce new error types.

Objective: Our objective was to evaluate the effect of the introduction of an electronic medical record (EMR) on the quality and safety of therapeutic anticoagulation management.

Methods: A retrospective, observational pre-/poststudy was conducted, analyzing real-world data across five hospital sites in a single health service. Four metrics were compared 1-year pre- and 1-year post-EMR implementation. They included clinician-reported medication incidents, toxic pathology results, hospital-acquired bleeding complications (HACs), and rate of heparin-induced thrombocytopenia. Further subanalyses of patients experiencing HACs in the post-EMR period identified key opportunities for intervention to maximize safety and quality of anticoagulation within an eMMS.

Results: A significant reduction in HACs was observed in the post-EMR implementation period (mean [standard deviation [SD]] =12.1 [4.4]/month vs. mean [SD] = 7.8 [3.5]/month; p = 0.01). The categorization of potential EMR design enhancements found that new automated clinical decision support or improved pathology result integration would be suitable to mitigate future HACs in an eMMS. There was no significant difference in the mean monthly clinician-reported incident rates for anticoagulants or the rate of toxic pathology results in the pre- versus post-EMR implementation period. A 62.5% reduction in the cases of heparin-induced thrombocytopenia was observed in the post-EMR implementation period.

Conclusion: The implementation of an EMR improves clinical care outcomes for patients receiving anticoagulation. System design plays a significant role in mitigating the risks associated with anticoagulants and consideration must be given to optimizing eMMSs.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Clinician-reported anticoagulant medication incidents and safety assessment code (SAC) pre- and post-EMR implementation. EMR, electronic medical record.
Fig. 2
Fig. 2
Clinician-reported anticoagulation clinical error types pre- and post-EMR implementation. EMR, electronic medical record.
Fig. 3
Fig. 3
Number of hospital acquired bleeds per anticoagulant type. Abbreviations: DOAC, direct-acting oral anticoagulant; IV, intravenous; LMWH, low molecular weight heparin; SC, subcutaneous.
Fig. 4
Fig. 4
Severity of bleeds (TIMI score)—first year post-EMR implementation ( n  = 87). EMR, electronic medical record; TIMI, Thrombolysis in Myocardial Infarction.
Fig. 5
Fig. 5
Count of clinical error type for hospital acquired bleeds in the post-EMR implementation period. EMR, electronic medical record.
Fig. 6
Fig. 6
Potential EMR enhancements to improve bleeding complications associated with anticoagulant use. CDSS, clinical decision support system; DI, drug interaction; EMR, electronic medical record.
Fig. 7
Fig. 7
Incidence of heparin induced thrombocytopenia (HITS) (12-month pre- and 12-month post-EMR-implementation). EMR, electronic medical record.
Fig. 8
Fig. 8
EMR user interface prompting weight-based dosing for UFH infusion orders. EMR, electronic medical record; UFH, unfractionated heparin.
See this image and copyright information in PMC

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