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Making safer preoperative arrangements for patients using vitamin K antagonists
Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
British Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278250/ https://www.ncbi.nlm.nih.gov/pubmed/28174658 http://dx.doi.org/10.1136/bmjquality.u212617.w5031 |
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author | van Fessem, Joris Willems, Jessica Kruip, Marieke Hoeks, Sanne Jan Stolker, Robert |
author_facet | van Fessem, Joris Willems, Jessica Kruip, Marieke Hoeks, Sanne Jan Stolker, Robert |
author_sort | van Fessem, Joris |
collection | PubMed |
description | Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework had not been implemented. Therefore, a quality-improvement project was started at the Anesthesia Department to improve perioperative safety. After exploration of barriers, multiple interventions were carried out to encourage co-workers at the preoperative screening department to take shared responsibility: distribution of prints, adjustments in electronic patient records, introduction of a protocol and education sessions. Efficacy was measured retrospectively performing a before-after study collecting perioperative data of patients using vitamin K antagonists. The primary outcome measure was the percentage of predefined safe preoperative plans. Secondary outcome measures were (1) incidence of postoperative bleeding and thrombo-embolic events within the first 24 hours after intervention and (2) necessity to preoperative correction of anticoagulation. Before intervention 72 (29%) safe, 93 (38%) partially unsafe and 83 (33%) unsafe arrangements were made. After the intervention these numbers were 105 (80%), 23 (17%) en 4 (3%), respectively: a significant 51% increase in safe preoperative plans (P<0.001). We observed no significant difference (P=0.369) regarding bleeding and thrombo-embolic events: pre-intervention 12 (5%) cases of postoperative bleeding were documented, vs. 6 (5%) post intervention and the number of thrombo-embolic events was 5 (2%) vs. 0. Also, no significant differences concerning preoperative correction of anticoagulation were observed: 11 (4%) vs. 8 (6%) (P=0.489). This quality improvement project demonstrates a major improvement in safer preoperative arrangements in our institution regarding vitamin K antagonists, using the described interventions. A significant effect on bleeding or thrombo-embolic events or necessity to correction of anticoagulation could not be demonstrated. |
format | Online Article Text |
id | pubmed-5278250 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | British Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-52782502017-02-07 Making safer preoperative arrangements for patients using vitamin K antagonists van Fessem, Joris Willems, Jessica Kruip, Marieke Hoeks, Sanne Jan Stolker, Robert BMJ Qual Improv Rep BMJ Quality Improvement Programme Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework had not been implemented. Therefore, a quality-improvement project was started at the Anesthesia Department to improve perioperative safety. After exploration of barriers, multiple interventions were carried out to encourage co-workers at the preoperative screening department to take shared responsibility: distribution of prints, adjustments in electronic patient records, introduction of a protocol and education sessions. Efficacy was measured retrospectively performing a before-after study collecting perioperative data of patients using vitamin K antagonists. The primary outcome measure was the percentage of predefined safe preoperative plans. Secondary outcome measures were (1) incidence of postoperative bleeding and thrombo-embolic events within the first 24 hours after intervention and (2) necessity to preoperative correction of anticoagulation. Before intervention 72 (29%) safe, 93 (38%) partially unsafe and 83 (33%) unsafe arrangements were made. After the intervention these numbers were 105 (80%), 23 (17%) en 4 (3%), respectively: a significant 51% increase in safe preoperative plans (P<0.001). We observed no significant difference (P=0.369) regarding bleeding and thrombo-embolic events: pre-intervention 12 (5%) cases of postoperative bleeding were documented, vs. 6 (5%) post intervention and the number of thrombo-embolic events was 5 (2%) vs. 0. Also, no significant differences concerning preoperative correction of anticoagulation were observed: 11 (4%) vs. 8 (6%) (P=0.489). This quality improvement project demonstrates a major improvement in safer preoperative arrangements in our institution regarding vitamin K antagonists, using the described interventions. A significant effect on bleeding or thrombo-embolic events or necessity to correction of anticoagulation could not be demonstrated. British Publishing Group 2017-01-27 /pmc/articles/PMC5278250/ /pubmed/28174658 http://dx.doi.org/10.1136/bmjquality.u212617.w5031 Text en © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/http://creativecommons.org/licenses/by-nc/2.0/legalcode |
spellingShingle | BMJ Quality Improvement Programme van Fessem, Joris Willems, Jessica Kruip, Marieke Hoeks, Sanne Jan Stolker, Robert Making safer preoperative arrangements for patients using vitamin K antagonists |
title | Making safer preoperative arrangements for patients using vitamin K antagonists |
title_full | Making safer preoperative arrangements for patients using vitamin K antagonists |
title_fullStr | Making safer preoperative arrangements for patients using vitamin K antagonists |
title_full_unstemmed | Making safer preoperative arrangements for patients using vitamin K antagonists |
title_short | Making safer preoperative arrangements for patients using vitamin K antagonists |
title_sort | making safer preoperative arrangements for patients using vitamin k antagonists |
topic | BMJ Quality Improvement Programme |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278250/ https://www.ncbi.nlm.nih.gov/pubmed/28174658 http://dx.doi.org/10.1136/bmjquality.u212617.w5031 |
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