Anticoagulants: can we enhance patient safety in this digital era?

Anticoagulants are used extensively in clinical practice for thrombotic and embolic disorders. They are considered high-risk medications due to a narrow therapeutic index. They are commonly implicated in adverse drug events of which it is reported 50-70% of these are potentially preventable. Governments are committing significant investment in electronic medical records (EMR) within hospitals to promote learning healthcare systems with improved accessibility, productivity, safety and interoperability. However, for anticoagulants limited research exists evaluating patient care outcomes following EMR implementation and optimal anticoagulant digital design strategies.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) released a ‘National Anticoagulant Incident Analysis’ following concerns raised around rising anticoagulant incidents. One of the four recommendations from the national incident analysis was to “continue to implement and optimise electronic medication management systems to facilitate the identification and prevention of missed doses, incorrect doses and duplicate therapy orders”.

Our research aimed to investigate the impact of EMRs on the safety and quality of therapeutic anticoagulation and to identify, develop and evaluate digital techniques to improve patient care outcomes.

Our findings demonstrated an association between EMR implementation and improved patient care outcomes for inpatient therapeutic anticoagulation management. System design played a significant role in mitigating the risks and consideration must be given to optimising electronic medication management systems (eMMS). Given the high-risk nature of anticoagulants our findings demonstrate EMR based computerised physician order entry in conjunction with clinical decision support systems are required to effectively manage anticoagulation. Real-time clinical analytics offers a viable solution, yet implementation challenges must be addressed.

This research provides important and contemporary information that helps inform future eMMS design to manage therapeutic anticoagulation. It offers digital hospitals a solution for harnessing routinely collected patient data to monitor the safety and quality of anticoagulant use.

The thesis can be accessed via: https://doi.org/10.14264/1a52ed3