Category: Federal Forum Posters
Purpose: While approximately 4,000 Veterans receive anticoagulants at a Veterans Affairs Medical Center (VAMC) annually, a subset of Veterans subsequently present with bleeding events. The VAMC recently implemented a dashboard which identifies Veterans prescribed anticoagulants presenting to the emergency room or inpatient admission with a bleeding or clotting event identified by International Classification of Disease (ICD-10) code. This quality improvement project aims to identify factors that influence bleeding events in Veterans prescribed anticoagulants and are identified by the dashboard. Bleeding events will be evaluated for precipitating factors to identify trends with future intervention potential.
Methods: The dashboard identifies Veterans with bleeding events who were prescribed direct oral anticoagulants (DOACs), warfarin, or low molecular weight heparin. All Veterans prescribed anticoagulants presenting to the VAMC emergency room or inpatient admission with a bleeding event and identified by the dashboard between 5/1/2018 and 12/31/2018 will be included. The primary objective of this quality improvement project is to identify factors that influence bleeding events in Veterans prescribed anticoagulants. The secondary objective is to assess if there are opportunities to implement potential interventions on any identified factors. Data points will include age, weight, height, calculated body mass index, serum creatinine, creatinine clearance, aspartate aminotransferase, alanine aminotransferase, hemoglobin, hematocrit, platelets, prothrombin time, international normalized ratio, ICD-10, indication for anticoagulation, duration of therapy, anticoagulation agent and dose, refill history, bleed assessment score, concurrent use of non-steroidal anti-inflammatory drugs, aspirin, P2Y12 inhibitors, alcohol use, drug interactions, and disease state interactions. Anticoagulation management will be assessed per national VA criteria, FDA product labeling for use, and local VAMC policy. These data points will be collected by data extraction and manual chart review. Based on potential trends in factors potentiating bleeding events, possible interventions will be considered.
Results: not applicable
Conclusion: not applicable
David Smith– PGY1 Pharmacy Resident, Orlando VAMC, Winter Springs, FL