Measure Information Form:
Percent of Patients Receiving Anticoagulant with Treatment Appropriately Managed According to Protocol
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving an anticoagulant whose treatment was ordered, received, and managed according to protocol or for whom protocol was not followed due to a documented contraindication
Goal: 100%
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition: Number of patients receiving an anticoagulant whose treatment was ordered, received, and managed according to protocol or for whom protocol was not followed due to a documented contraindication
Numerator Exclusions: Same as denominator exclusions
Denominator Definition: Number of patients receiving an anticoagulant
Denominator Exclusions:
Temporary residents
Measurement Period Length: Monthly
Definition of Terms:
Appropriate contraindication: contraindications should be defined in the protocol.
Anticoagulant treatment: the process of ordering, delivering, and managing an anticoagulant. Note that a single treatment may include multiple doses, and does not only include the initial ordering and delivery of the medication, but extends through the entire management of the treatment, until discontinuation.
- Protocol- Practice protocol should be based on national guidance e.g. NPSA guidance.
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The purpose of this measure is to determine the reliability of the process in place. It is intended to be used in those situations where a practice has already adopted a protocol for the management of a selected high-alert medication.
Where a practice does not have a protocol in place this should be developed using national guidance e.g. NPSA.
We recommend that practices use measures like this one to track protocol compliance within medication categories (i.e.., narcotics, anticoagulants, insulin, and sedatives) separately, which will help target compliance issues more easily.
COLLECTION STRATEGY:
Identify patients who received anticoagulants from the practice system. In line with NPSA guidance all should have a medication review within the previous 12 months.This review could be used to determine protocol is being followed.
If a single patient has more than one distinct anticoagulant treatment during their admission, consider only the first in this measure.
Sampling Strategy:
Each month, review a minimum of 10 patient records with at least one anticoagulant treatment. You can conduct reviews over multiple sessions (for example, 5 records every 2 weeks) to spread out the need for resources. If you have fewer than 10 records after making any appropriate exclusions, use as many records as fit the inclusion criteria.
Measure Information Form:
Percent of Patients Receiving Anticoagulant without appropriate written clinical information e.g. indication, target INR, stop date
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving an anticoagulant without appropriate written clinical information e.g. indication, target INR, stop date recorded in their primary care notes
Goal:0%
Matches Existing Measures: NPSA
CALCULATION DETAILS:
Numerator Definition: Number of patients receiving an anticoagulant without appropriate written clinical information e.g. indication, target INR, stop date recorded in their primary care notes
Numerator Exclusions: Same as denominator exclusions
Denominator Definition: Number of patients receiving an anticoagulant
Denominator Exclusions:
Temporary residents
Measurement Period Length: Monthly
Definition of Terms:
- Indication- diagnosis or indication of treatment is recorded
- Target INR- the range that is required for the relevant indication
- Stop date- the date after which treatment should be discontinued
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The purpose of this measure is to determine whether adequate clinical information is recorded within the patients’ notes to allow safe prescribing of the drug. The NPSA alert 18 recommends that all patients have written clinical information in their notes to allow prescribers to manage treatment appropriately. Annual review is also a recommendation and this could be a useful tool to update any missing data.
COLLECTION STRATEGY:
Identify patients who received anticoagulants from the practice system. In line with NPSA guidance all should have a medication review within the previous 12 months, at this review details should be checked and entered as appropriate to update fully the patients’ clinical information.
Sampling Strategy:
Each month, review a minimum of 10 patient records with at least one anticoagulant treatment. You can conduct reviews over multiple sessions (for example, 5 records every 2 weeks) to spread out the need for resources. If you have fewer than 20 records after making any appropriate exclusions, use as many records as fit the inclusion criteria.
Measure Information Form:
Adverse Drug Events Related to Anticoagulant in previous month with Anticoagulant Administered
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The number of adverse drug events (ADEs) associated with an anticoagulant per month in which the patient was administered at least one dose of an anticoagulant.
Goal: Reduce by 50% within 24 months.
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition: Number of ADEs recorded with associated anticoagulant use recorded in practice data
Numerator Exclusions: Same as denominator exclusions
Denominator Definition: Number of patients receiving anticoagulants
Denominator Exclusions: none
Measurement Period Length: Monthly
Definition of Terms:
Adverse Drug Event (ADE): Any event that is recoded as an ADE to anticoagulation e.g. major bleed
Calculate as: (numerator/ denominator) x 100; as a rate
Comments:
All ADEs should be read coded when input into the practice system to allow more easily retrievable data. A list of suitable codes should be available to prescribers to ensure retrospective searches can be performed.
COLLECTION STRATEGY:
A practice search should be run monthly on the read codes associated with ADEs relating to anticoagulant use to determine patient number.
Sampling Strategy:
A monthly search should identify all patients affected. Each patient should then receive a notes review to determine if the ADE was preventable and help to inform future safety measures as a result.
Measure Information Form:
Percent of Patients Receiving Warfarin With INR Outside Target Limits
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving warfarin with INR outside the safety limits defined by their target INR range recorded in practice notes
Goal: Reduce by 80%
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition:The percentage of patients receiving warfarin with INR outside the safety limits defined by their target INR range recorded in practice notes
Numerator Exclusions:Same as denominator exclusions
Denominator Definition: Number of patients receiving warfarin
Denominator Exclusions:
- Temporary residents
Measurement Period Length: Monthly
Definition of Terms:
INR Target range: The range of INR measurement that is considered safe for a given indication in line with national guidance (NPSA and British Committee for Standards in Haematology)
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The range of INR measurement that is considered safe for a given indication is set out in national guidance that has been prepared by the British Committee for Standards in Haematology. This guidance should be used to determine the safe limits that should be recorded within the patients’ medical record within the practice, in addition to their diagnosis or indication for treatment.
COLLECTION STRATEGY:
Patients receiving warfarin may be identified through the practice records. These patients—or a sample of them—represent your denominator. Patients with INR levels outside of protocol limits will be identified using lab records, and reconciling this data with the patients’ safe range as indicated in their practice notes.
Sampling Strategy:
We recommend a sample of 20 patients per month. A random selection of patients should be selected and current INR level cross checked with their safe range as indicated in their practice notes.
Measure Information Form:
Percent of Patients Receiving Warfarin With INR >5 but <8
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving warfarin with INR greater than 5 but less than 8
Goal: Reduce by 80%
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition:The percentage of patients receiving warfarin with INR greater than 5 but less than 8
Numerator Exclusions:Same as denominator exclusions
Denominator Definition: Number of patients receiving warfarin
Denominator Exclusions:
- Temporary residents
Measurement Period Length: Monthly
Definition of Terms:
- INR >5 but <8 - An INR from 5 to 7.9
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The range of INR over 5 is considered to be associated with increased adverse drug events. The purpose of this measure is to identify patients within this range and recify the level to that which is considered safe for their indication.
COLLECTION STRATEGY:
Patients receiving warfarin may be identified through the practice records. These patients—or a sample of them—represent your denominator. Patients with INR levels <5 but >8 limits will be identified using INR lab results.
Sampling Strategy:
All patients within this range should be identified and a process should be in place whether in practice or by referring to an outside anticoagulation clinic, to treat patients and return levels to within the safe range associated with their indication
Measure Information Form:
Percent of Patients Receiving Warfarin With INR >8
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving warfarin with INR greater than 8
Goal: Reduce by 80%
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition: The percentage of patients receiving warfarin with INR greater than 8
Numerator Exclusions:Same as denominator exclusions
Denominator Definition: Number of patients receiving warfarin
Denominator Exclusions:
- Temporary residents
Measurement Period Length: Monthly
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The range of INR over 8 is considered to be associated with increased adverse drug events. The purpose of this measure is to identify patients within this range and rectify the level to that which is considered safe for their indication.
COLLECTION STRATEGY:
Patients receiving warfarin may be identified through the practice records. These patients—or a sample of them—represent your denominator. Patients with INR levels <8 will be identified using INR lab results.
Sampling Strategy:
All patients within this range should be identified and a process should be in place whether in practice or by referring to an outside anticoagulation clinic, to treat patients and return levels to within the safe range associated with their indication
Measure Information Form:
Percent of Patients Receiving Warfarin With no INR on record
Intervention(s): Prevent Harm from High-Alert Medications
Definition: The percentage of patients receiving warfarin with no INR recorded in practice notes
Goal: Reduce by 80%
Matches Existing Measures: N/A
CALCULATION DETAILS:
Numerator Definition: The percentage of patients receiving warfarin with no INR recorded in practice notes
Numerator Exclusions:Same as denominator exclusions
Denominator Definition: Number of patients receiving warfarin
Denominator Exclusions:
- Temporary residents
Measurement Period Length: Monthly
Definition of Terms:
INR Target range: The range of INR measurement that is considered safe for a given indication in line with national guidance (NPSA and British Committee for Standards in Haematology)
Calculate as: (numerator / denominator) x 100; as a percent
Comments:
The range of INR measurement that is considered safe for a given indication is set out in national guidance that has been prepared by the British Committee for Standards in Haematology. This guidance should be used to determine the safe limits that should be recorded within the patients’ medical record within the practice, in addition to their diagnosis or indication for treatment.
COLLECTION STRATEGY:
Patients receiving warfarin may be identified through the practice records. These patients—or a sample of them—represent your denominator. Patients with INR levels outside of protocol limits will be identified using lab records, and reconciling this data with the patients’ safe range as indicated in their practice notes.
Sampling Strategy:
We recommend a sample of 20 patients per month. A random selection of patients should be selected and current INR level cross checked with their safe range as indicated in their practice notes.
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