Documenting Anticoagulation Recommendations Postprocedure

ASGE Quality Endoscopy Unit Recognition Program

Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this month leveraged the unit’s participation in the GIQuIC registry to look at documenting anticoagulation recommendations postprocedure. They had a practical solution and a measurable outcome.

DEFINE

To monitor the physician's procedure report and the patient's discharge report for documentation that patients taking an anticoagulant (i.e., Coumadin, Xarelto, Eliquis, Plavix) before the procedure are instructed on when to resume it after the procedure.

MEASURE

  • Data are taken from the GIQuIC registry, which includes patients receiving anticoagulation therapy.
  • Data are also collected from the logbook, which pre-op nurses are required to use to document anticoagulation therapy used by any patient who undergoes a procedure.
  • We were looking for 100 percent compliance from each physician.

ANALYZE and IMPROVE

  • The anticoagulation quality improvement project started in September 2017 and ended in December 2022, when every physician achieved the goal of 100 percent compliance.
  • Every physician had a different baseline: most doctors were documenting resume dates for the anticoagulation therapy 75 to 100 percent of the time; however, two outliers fell below 50 percent of the time.
  • Quality improvement methods:
    • Started with RNs in pre-op calling the procedure room to notify the nurse and physician of the patient's name, which anticoagulant therapy the patient used and the date that the medication was held.
    • In addition, the medical director spoke to the individual physicians who were not documenting resume dates for anticoagulation therapy.
    • The nurse managers emailed the quality improvement project findings to all the physicians to show them our measurement findings.
    • The last tool used was brightly colored anticoagulation stickers added to patients’ charts and the schedule in the recovery room to identify the patients using anticoagulation therapy. The sticker is a reminder to the discharge nurse, technician and physician to ensure the discharge report includes documentation of the resume date and that the date has been communicated to the patient. With these measures, all physicians were 100 percent compliant in documenting the resume dates for anticoagulation therapy.

SUMMARY

The staff and physicians were notified through staff meetings and emails, with the data sent to all the physicians, that the goal of 100 percent compliance was met. Anticoagulation stickers are still being utilized, and a log of patients receiving anticoagulation therapy is maintained for periodic reviews to confirm compliance with documentation on resume dates for anticoagulation therapy.

We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle, and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.