From: Subject: Self Assessment of Core and Target Safe Practices for Use of Anticoagulants Date: Mon, 11 Aug 2008 16:13:03 -0400 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0039_01C8FBCD.21B77DC0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3198 This is a multi-part message in MIME format. ------=_NextPart_000_0039_01C8FBCD.21B77DC0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.ismp.org/selfassessments/hcif/resultsscores.asp Self Assessment of Core and Target Safe Practices for = Use of Anticoagulants
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Self Assessment results of Core = and=20 Target Safe Practices for Use of = Anticoagulants


Core Safe Practices-Group = A
Recommended=20 Practice from ISMP		  
1. Use a standard weight-based = heparin=20 protocol for each indicated use of a heparin = infusion=20
Fully implemented in some areas 20%
Fully implemented throughout 50%
Not implemented 30%
2. Use standardized, weight-based heparin = infusion=20 charts or nomograms to determine bolus doses and = infusion rates
Fully implemented in some areas 20%
Fully implemented throughout 60%
Not implemented 20%
3. Affix infusion rate charts=20 (preprinted on labels) to heparin infusion = bags
Fully implemented throughout 50%
Not implemented 50%
4. Use the patient=92s actual weight = in=20 kilograms (kg) (or ideal body weight if = indicated) as=20 the basis for determining heparin doses
Fully implemented in some areas 11%
Fully implemented throughout 74%
Not implemented 16%
5. Do not abbreviate units as = =93U=94
Fully implemented in some areas 5%
Fully implemented throughout 95%
6. Use only free-flow protected pumps to = administer=20 heparin infusions
Fully implemented throughout 94%
Not implemented 6%
7. Standardize the concentration = used=20 for therapeutic heparin
Fully implemented in some areas 5%
Fully implemented throughout 90%
Not implemented 5%
8. Use commercially prepared, premixed IV = heparin=20 solutions
Fully implemented in some areas 5%
Fully implemented throughout 90%
Not implemented 5%
9. Use unit-dose syringes for = adult=20 heparin flushes to differentiate them from other = injectable products that are packaged in vials = (e.g.,=20 insulin, normal saline) and to avoid potential=20 contamination of vials
Fully implemented throughout 32%
Not implemented 68%
10. Administer bolus doses directly from a=20 pharmacy-prepared syringe connected to an IV = access port=20 (unless a =93smart pump=94 is utilized and can = alert the=20 nurse to resume the maintenance infusion rate = after the=20 bolus dose has been administered)
Fully implemented in some areas 15%
Fully implemented throughout 25%
Not implemented 60%
11. Obtain baseline laboratory = tests=20 (e.g., hemoglobin, hematocrit, serum creatinine, = platelet count, INR, aPTT) before prescribing=20 anticoagulants
Fully implemented throughout 85%
Not implemented 15%
12. Develop and follow a standard format for=20 communicating to the pharmacy any dose = adjustments based=20 on laboratory values
Fully implemented in some areas 5%
Fully implemented throughout 55%
Not implemented 40%
13. Eliminate the use of heparin = flushes=20 for peripheral venous access catheters
Fully implemented throughout 85%
Not implemented 15%
14. Dispense and administer warfarin in=20 patient-specific doses (e.g., 2 mg, 4 mg, 5 mg) = at a=20 standard time that allows sufficient time to = review=20 daily laboratory results and make necessary dose = adjustments
Fully implemented in some areas 5%
Fully implemented throughout 90%
Not implemented 5%
15. Maintain functional drug = interaction=20 alerts for anticoagulants that appear when = appropriate=20 upon entering an order into the = pharmacy/prescriber=20 order entry system(s)
Fully implemented in some areas 10%
Fully implemented throughout 80%
Not implemented 10%
16. Reconcile medication upon admission, = transfer,=20 and discharge
Fully implemented in some areas 35%
Fully implemented throughout 60%
Not implemented 5%
Core Safe Practices-Group = B
Recommended=20 Practice from ISMP		  
1. Develop and implement=20 Interdisciplinary Treatment and Monitoring = Guidelines=20
Fully implemented in some areas 20%
Fully implemented throughout 30%
Not implemented 50%
2. Establish and follow a strategy for = resuming=20 =93hold=94 orders
Fully implemented in some areas 5%
Fully implemented throughout 65%
Not implemented 30%
3. Require pharmacy to dispense = all=20 anticoagulant medications, or require pharmacy=20 verification of all orders for anticoagulants = before=20 removal from unit stock and/or automated = dispensing=20 cabinets (no overrides)
Fully implemented in some areas 30%
Fully implemented throughout 45%
Not implemented 25%
4. Provide single use or unit-dose packages to = patient care units
Fully implemented in some areas 5%
Fully implemented throughout 95%
5. Use standard order sets or = preprinted=20 orders for anticoagulants
Fully implemented in some areas 47%
Fully implemented throughout 16%
Not implemented 37%
6. Use protocol and/or preprinted orders for=20 evaluation and treatment of heparin-induced=20 thrombocytopenia (HIT)
Fully implemented in some areas 15%
Fully implemented throughout 5%
Not implemented 80%
7. Employ strategically placed=20 independent double checks (unfractionated = heparin)
Fully implemented in some areas 20%
Fully implemented throughout 50%
Not implemented 30%
8. Restrict access to multiple concentrations = of=20 heparin (in vials and syringes) in the hospital, = the=20 pharmacy, and on patient care units
Fully implemented in some areas 21%
Fully implemented throughout 63%
Not implemented 16%
9. When clinical unit stock of = heparin=20 is appropriate, provide the smallest size = packages and=20 the fewest doses necessary to meet the needs of = patients=20 between each restocking period
Fully implemented in some areas 5%
Fully implemented throughout 95%
10. Dispense heparin flush solutions from the=20 pharmacy in the concentration required for the = patient=20 population and/or device in use (requiring no = further=20 dilution on the unit)
Fully implemented throughout 90%
Not implemented 10%
11. Safely select, procure, and = store=20 anticoagulants
Fully implemented in some areas 5%
Fully implemented throughout 95%
12. Prevent unsafe concomitant administration = of=20 anticoagulants
Fully implemented in some areas 10%
Fully implemented throughout 75%
Not implemented 15%
13. Establish inpatient clinical = pharmacy anticoagulation services and outpatient = warfarin dosing services
Fully implemented in some areas 5%
Not implemented 95%
14. Use process control charts to display = trends and=20 assist with dosing
Fully implemented in some areas 20%
Not implemented 80%
15. Make coagulation test = results=20 available in 2 hours or less
Fully implemented in some areas 20%
Fully implemented throughout 60%
Not implemented 20%
16. Use anticoagulation flow sheets designed = for use=20 during the inpatient stay, and provided them to=20 patients/transfer facility upon discharge for = continued=20 use
Fully implemented throughout 15%
Not implemented 85%
17. Teach patients = self-monitoring and=20 administration of prescribed anticoagulants =
Fully implemented in some areas 20%
Fully implemented throughout 45%
Not implemented35%
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=A9 2008 Institute for Safe = Medication=20 Practices. All rights=20 = reserved
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