by Robin Desrocher
Managing the risks associated with anticoagulation therapy falls in the hands of physicians across all specialties. Proper management can reduce the chance of patients being harmed. In recent years, several malpractice claims at TMLT have involved improper management of anticoagulant medicines in one way or another. (Please see the closed claim studies in the 2011 Neurology Reporter; 2012 Cardiology Reporter; 2012 Primary Care Reporter, and the 2012 Internal Medicine Reporter.)
When prescribing and/or maintaining these high-risk medications, some risk management concerns to consider are as follows:
- When delegating any portion of the anticoagulation monitoring process to a staff member, ensure competencies are up to date and documented.
- Review current medications at every patient encounter to ensure they are on the correct dosage and not experiencing side effects or drug interactions that would require adjustments.
- Medication reconciliation should occur upon hospital admission and discharge to reduce the chances of duplications, omissions, or incorrect dosages.
- Written and verbal instructions should be provided to the patients and/or caregivers at the initiation of therapy, and along the continuum of care. It is important that this education be in simple terms. It should include the risks and benefits of the medication.
- Keep the lines of communication open between all health care providers involved in the care of the patient, and document any discussions or written correspondences.
- Have written protocols in place outlining:
- How often to monitor therapy and adjust dosages, including identification of critical values (both high and low) and when physician notification is required.
- How to document the test results and treatment plan
- How to handle patient non-compliance
Even when all of these things are in place or conducted, patients may still suffer an adverse event due to anticoagulation therapy. Documenting the safe practice protocols and all of the care provided by you and your staff members is helpful in increasing the defensibility of a claim surrounding this high risk class of medication.