Patient Safety and Practice Assessment
For an anticoagulated patient undergoing a planned invasive procedure for which interruption in anticoagulation is anticipated, including patients taking vitamin K antagonists (warfarin), target specific oral anticoagulants (such as apixaban, dabigatran, and rivaroxaban), and heparins/low molecular weight heparins, documentation, including through the use of electronic tools, that the plan for anticoagulation management in the periprocedural period was discussed with the patient and with the clinician responsible for managing the patient’s anticoagulation. Elements of the plan should include the following: discontinuation, resumption, and, if applicable, bridging, laboratory monitoring, and management of concomitant antithrombotic medications (such as antiplatelets and nonsteroidal anti-inflammatory drugs (NSAIDs)). An invasive or surgical procedure is defined as a procedure in which skin or mucous membranes and connective tissue are incised, or an instrument is introduced through a natural body orifice.
Formalize and document a standardized process for management of patients on anti-coagulant medication before, during, and after invasive procedures, thus reducing risk of complications.
Create a standardized process for managing patient anti-coagulation during the peri-procedural period for planned invasive procedure for which interruption in anticoagulation is anticipated. Include all of the following elements:
1) Identification of patients needing anticoagulation management – Documentation of a process to identify patients taking anticoagulants including vitamin K antagonists (warfarin), direct oral anticoagulants (such as apixaban, dabigatran, and rivaroxaban), and heparins/low molecular weight heparins for anticoagulation medication management plan; AND
2) Documented discussion – Standardized documentation (e.g., medical record note with standardized components, pre-procedural document maintained in the medical record) of specific plan for managing patient anti-coagulation before, during, and after surgery by relevant eligible clinicians (such as primary care clinician, hospitalist, surgeon, or anesthesiologist); AND
3) Examples of anti-coagulation management plans – Examples of documented plans (e.g., medical record, electronic health record, secure email) for anticoagulation management in the periprocedural period for planned invasive procedures. The plan should include the following: discontinuation, resumption, and, if applicable, bridging medication, laboratory monitoring, and management of concomitant antithrombotic medications (such as anti-platelet and nonsteroidal anti-inflammatory drugs).