Anticoagulation Working Group

Meeting 5, 2.00pm to 4.00pm (AEST), Monday 16 January 2012

Teleconference

Meeting 5 Outcomes

Members

Ms Margaret Duguid / Pharmaceutical Advisor, Chairman / ACSQHC
Ms Jaclyn Baker / Statewide Medication Coordinator, Department of Health and Human Services / TAS
Ms Naomi Burgess / Pharmacy Consultant
Medication Safety, Pharmaceutical Services and Strategy Branch, SA Health / SA
Dr Kerrie Westaway / Senior Project Officer, Medication Safety, Pharmaceutical Services and Strategy Branch, Department of Health / SA
Ms Gillian Sharratt / Executive Officer, NSW Therapeutic Advisory Group / CATAG
Ms Annette Lenstra / Senior Policy Officer, Quality Improvement Directorate, Performance Activity and Quality Division, Department of Health / WA
Prof Alex Gallus / Professor of Haematology and Genetic Pathology, FlindersUniversity / SA
Ms Gabrielle Couch / Technical Advisor, Clinical Safety and Quality and Governance Branch, Department of Health / NSW
Ms Carol Reid
Ms Sarah Mathers / Safe Medication Practice Unit, Medication Services Queensland / Qld
Mr Daniel Lalor / Project Manager, Medication Safety,
Clinical Excellence Commission / NSW
Ms Bridie Carr
Ms Lyn Farthing / Agency for CIinical Innovation / NSW

Office of the Commission

Mr Graham Bedford / Policy Team Manager / ACSQHC
Ms Helen Stark / Senior project officer, Medication SafetyProgram / ACSQHC

Apologies

A/Prof Michael Woodward / Medical Director Aged and Residential Care Services, Austin Health / Vic
Dr Martin Gallagher / Senior Research Fellow, George Institute / NSW
Ms Angela Wai / Senior project officer, Medication Safety Program / ACSQHC

MEETING OUTCOMES:

  1. Members were welcomed and apologies noted.
  2. There were no conflicts of interestdeclared.
  3. Outcomes from Meeting 4 held on 7 September 2011 were noted and confirmed without change.
  4. Business arising

Members noted that the ACSQHCplans to contact those hospitals with high rates of mechanical prophylaxis prescribing to identify resource materials to improve the documentation of the use of mechanical prophylaxis. There was discussion and agreement that the key to achievingimproved rates of mechanical prophylaxis prescribing was ongoing training and education of clinicians.

  1. NIMC with redesigned VTE prophylaxis section.

Members noted the decision of the Health Services Medication Expert Advisory Group to retain a tripartite VTE section comprising risk assessment and pharmacological and mechanical prophylaxis prescribing, and to extend the pilot to a second phase. Members agreed that a second phase pilot would provide hospitals with access to a NIMC with VTE section while providing additional data for analysis. The draft NIMC that will be used in the Phase 2 pilot will contain a revised VTE section that has been modified to address the issues identified in the first phase of the pilot. It was noted that the pharmacological VTE medication box required the words “print generic name” to be added for it to be consistent with the rest of the NIMC.

Action: The ACSQHC will include the words “print generic name” in the medication box in VTE section

Phase 1 sites will be able to transition to the new chart when it becomes available.

  1. Phase 1 12 month post implementation audit.

Members noted that Phase 1 pilot hospitals had been encouraged to undertake an audit 12 months after introducing the pilot NIMC however to date only two hospitals had submitted their reports. Reasons for the poor response included:

  • Directive from NSW Health for hospitals to cease using the chart;
  • Hospitals decision not to continue using the chart.

Data received to date from the two hospitals showed a similar response rate to that seen after 3 months.

  1. NIMC VTE Pilot Phase 2 methodology.

Members considered the proposed methodology andtimelines for the Phase 2 pilot. The following was agreed:

  • The post implementation audit timeline will be extended to 30 November 2012 to allow for a period of 6 – 9 months after introducing the chart before data collection;
  • There will be no 12 month post-implementation audit;
  • Sample size will be the same as the Phase 1 audit however large hospitals will be encouraged to do more than 60 patients;
  • The same performance measures will be used with the addition of a measure to assess prescribing in accordance with local hospital policy. This component of the audit will only apply to those hospitals with policies/guidelines and will enable hospitals to assess whether VTE prophylaxis is prescribed in conformance with their guidelines;
  • Phase 2 pilot sites will complete a qualitative online survey to provide feedback on their experiences with the pilot as occurred in Phase 1; and
  • Pending the pilot final report, the NIMC with VTE prophylaxis section will be available for introduction nationally in mid-2013

Members noted that print production timelines for the pilot NIMC need to be factored into the timeframes. The extended timelines will provide more time for printing.

Action:Jurisdictional representatives to confirm print production timeframes and report back to the Senior Project Officer.

  1. Survey of medical staff.

Members considered the proposal to survey Medical Officers’ on their views on the inclusion of a VTE prophylaxis section on the NIMC. Members agreed that this would provide additional useful information for implementation of the chart nationally.

  1. Literature review on anticoagulation charts.

Members discussed the literature review on separate anticoagulation charts prepared for ACSQHC. There was limited evidence in the literature on the use of specific medication charts for anticoagulation. Members agreed that it would be very difficult to achieve consensus on a standardised heparin chart that contained decision support for use nationally. There was also the issue of a variety of concentrations of heparin infusion used nationally, these would first need to be standardised before developing a standardised chart. It was noted that some jurisdictions already had introduced standard heparin charts and WA had an anticoagulation chart. Members recommended that the ACSQHC not proceed with a national heparin chart but make examples of charts and general principles for safe management of heparin available from the ACSQHCwebsite.

Action: The ACSQHC will develop a web page with examplesof heparin charts and information on safe management of heparin infusions.

  1. Other business.

Correspondence from NSW Health

Members noted the letter from NSW Health to the ACSQHCadvising that they did not support the inclusion of the VTE prophylaxis section on the NIMC.

Correspondence from NHMRC

Members also noted the letter from the NRMRC to the ACSQHC advising that they have completed their program of work in VTE prevention and will no longer be involved in activities in this area.

VTE risk assessment training tool

Members discussed the value of ACSQHC developing an online teaching resource on VTE risk assessment. It was noted that this would be a challenging piece of work.

Action: The ACSQHC will discuss the development of a teaching resource for VTE risk assessment with personnel involved in the NHMRC VTE prevention program.

  1. Next meeting. The Senior Project Officer will send out some suggested dates for the next meeting.

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