Establishing a multidisciplinary taskforce to improve anticoagulation safety at a large health system

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To describe the development of a multidisciplinary anticoagulant safety taskforce (ASTF) to address anticoagulation-related issues across the medication-use system. Summary Oral and parenteral anticoagulants have been classified as high-alert medications because of their potential for harm. Errors at the point of prescribing, monitoring, and administering therapy have been noted in safety literature. Our hospital system, which includes 1 academic medical center, 6 community hospitals, and 1 long-term care facility, designed a multidisciplinary ASTF to address anticoagulation-related issues. The ASTF used the 2017 Institute for Safe Medication Practices (ISMP) Medication Safety Self-Assessment for Antithrombotic Therapy as the primary tool for reviewing current practices, performing gap analyses, and identifying our greatest areas of opportunity. The top 8 best practice elements related to anticoagulant use were identified for initial efforts of ASTF activity. Meetings were led by a medication safety pharmacist who reviewed process opportunities and actions to address gaps. The hospital chief quality and patient safety officer and the vice president of quality were the executive sponsors of the ASTF. Key stakeholders such as the medication safety committee chair and the president of the medical staff were instrumental in leading the initiative. Recommendations from the ASTF were reviewed and approved by the system medication safety committee and the system pharmacy and therapeutics committee to support system-wide implementation. The ASTF accomplished more than initially planned within its first year. Error mitigation occurred through policy revisions, order set development and modification, and implementation of practice changes to comply with each best practice. The ISMP antithrombotic self-assessment score improved from 67% to 87%, surpassing the initially targeted score of 75%. To overcome implementation barriers with the electronic health record, we enlisted support from our informatics leadership to leverage information technology. Overall, the success of the taskforce was attributed to the teamwork and leadership of key individuals within the organization. Conclusion Leveraging interest from key stakeholders across multiple disciplines with an established assessment tool was key to developing a productive and successful ASTF. The group came together to evaluate anticoagulant-related issues and implement sustainable changes to decrease anticoagulation error potential.

A Few Covid Vaccine Recipients Developed a Rare Blood Disorder.

EMA’s safety committee (PRAC) has concluded today that unusual blood clots with low blood platelets should be listed as very rare side effects of Vaxzevria (formerly COVID-19 Vaccine AstraZeneca). In reaching its conclusion, the committee took into consideration all currently available evidence, including the advice from an ad hoc expert group. EMA is reminding healthcare professionals and people receiving the vaccine to remain aware of the possibility of very rare cases of blood clots combined with low levels of blood platelets occurring within 2 weeks of vaccination. So far, most of the cases reported have occurred in women under 60 years of age within 2 weeks of vaccination. Based on the currently available evidence, specific risk factors have not been confirmed.

A strategic guide for the development of a corporate sepsis program

Background: Sepsis is a major health burden. Guidelines call for healthcare providers to establish sepsis care improvement programs to enhance patient care and outcome. A comprehensive sepsis program has been developed at Hamad Medical Corporation (HMC) and implemented across its 13 facilities before embarking on a bigger journey. Methods: Senior leadership engagement and collaboration with pertinent departments are key to any initiative's success. A subject matter expert was appointed as Clinical Lead and Chair of the Program and held accountable to sponsors. Stakeholders were identified and invited to participate in the corporate steering group. Given that facilities may have differing challenges, patient population, or resources, a facility-level sepsis committee was established adopting a similar structure to the corporate committee. Each facility committee reviewed, implemented, and reported to the respective local quality and safety committee. Training, reporting and monitoring were undertaken at the local followed by the corporate level. Standardized sepsis pathways and guidelines were developed and implemented. Monitoring is crucial to ensure a program remains on track. This was attained using a corporate dashboard in which all cases of sepsis, irrespective of facility, time or age were reported and reviewed. Regular reports were sent to the Corporate Quality Improvement and Safety Committee. This, subsequently, is discussed at the Executive Management Committee. Findings: The implementation of a Corporate Sepsis Program was successful and extended to include other organisations (Sidra Medicine, Primary Health Care Corporation and the Qatar Red Crescent). An education subcommittee designed and delivered a nursing training program and e-learning as a collaboration between the Hamad International Training Centre (HITC), clinical and nursing informatics, and medical and nursing education. This resulted in timely and appropriate management. Conclusion: HMC Sepsis Program improved sepsis outcome in Qatar. A systematic approach, application of evidence-based practice, staff empowerment, senior leadership engagement, a clear structure of governance, quality assurance and reporting are critical elements of its success.

Safety Aspects of Perinatal Ultrasound

Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.

DIC-Like Syndrome Following Administration of ChAdOx1 nCov-19 Vaccination

In recent weeks, adverse reactions have been reported after administration of Oxford–AstraZeneca chimpanzee adenovirus vectored vaccine ChAdOx1 nCoV-19 (AZD1222), in particular thrombus formation, which has led several European Countries to discontinue administration of this vaccine. On March 8, 2021, the European Medicines Agency Safety Committee did not confirm this probable association. We report the case of a patient who developed disseminated intravascular coagulation after the first dose of Oxford-Astra Zeneca vaccine, which resolved in a few days with the administration of dexamethasone and enoxaparin. This work demonstrates the safety of the Oxford-Astra Zeneca vaccine and that any development of side effects can be easily managed with a prompt diagnosis and in a short time with a few commonly used drugs.

301 Evaluation of Fatigue and Healthy Lifestyle Practices among New York State Law Enforcement Professionals

Introduction An important risk factor for drowsy driving is shift work, and law enforcement, an occupation known for its atypical work schedules, is a highly vulnerable occupation. A connection between fatigue and unintentional injuries among police officers has been observed (Vila, 2006), but data supporting the connection is limited. Understanding how sleep and lifestyle practices impact this population’s driving performance and job safety is critical to officer safety. Methods An online survey was disseminated to New York State law enforcement agencies by the Governor’s Traffic Safety Committee to assess sleep health and lifestyle practices among law enforcement personnel. Statistical analysis included data cleaning, basic and advanced statistical testing. Results 7,366 survey invitations were distributed, 1,171 were returned (15.9% response rate), and after data cleaning, 1,038 surveys were included in the analysis. Respondents reported from various state, county, and local agencies, holding titles from Police Officer to Senior Management. More than 30% of officers reported driving 5 hours or more during their shift, with 12% driving greater than 7 hours. 65% of respondents reported having experienced drowsy driving. Although, 34% reported never having received education about drowsy driving. On work days, only 40% of respondents obtain 7 hours of sleep or more. On days off, 23.6% reported sleeping 6 hours or less. Work, stress, and family responsibilities were reported as having a significant impact on sleep. Almost 87% reported at least one medical issue. Daytime sleepiness (47.4%), fatigue (42.6%), and poor memory (26.8%) were reported daily. Only 23.8% and 29.3% of respondents received education on sleep or heart health, respectively. The majority (81.7%) reported they would consider education in a variety of health-related programs. Conclusion Our findings indicate that poor sleep (60%), high stress (22.7%), and anxiety (16.8%) are a concern amongst officers. Poor cardiovascular health was also noted, based on reports of obesity (34.1%), high blood pressure (23.5%), and high cholesterol (22.4%). This research supports the need for prioritizing health education programs within law enforcement agencies. Support (if any) Funded by The National Highway Traffic Safety Administration with a grant from The New York State Governor’s Traffic Safety Committee.