Category: All Resources

Managing the Risks of Direct Oral Anticoagulants

The Joint Commission: Sentinel Event Alert

While DOACs offer ease of use to patients, stopping bleeding events in patients on DOACs is more complicated, requiring different strategies than those for patients on warfarin (Coumadin®) and heparin. Unlike the more widely available reversal agents for warfarin and heparin, reversal agents for DOACs are lesser known and may not be available in every care setting. Also, some DOACs have no FDA-approved reversal agent at this time. Therefore, bleeding complications can be severe if these patients are not assessed according to guidelines on the management of DOACs. Intracranial hemorrhage is the most serious emergent bleeding risk.

In response to an increase in adverse events related to these widely prescribed medications, this alert provides guidance on the safe use and management of DOACs to all medical practitioners and health care organization leaders, particularly chief medical officers, pharmacists, emergency department clinicians, and quality and safety officers.

Anticoagulation FORUM: Numerous Resources and Expert Guidance

Anticoagulation FORUM

  • Education & Guidance
  • Webinars and Events
  • Centers of Excellence
  • Anticoagulation Stewardship

Established more than 25 years ago, the Anticoagulation Forum is the largest organization of its kind helping practitioners improve patient care by providing current and relevant information on best practices. The flagship program, the Anticoagulation Centers of Excellence, embodies our commitment to the clinical application of evidence-based practices and improved patient outcomes. Expert Guidance is provided by the Board of Directors, who are regularly relied upon for their expert opinion. Their contributions to research and guideline development have influenced all aspects of anticoagulation therapy.

Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement

Agency for Healthcare Research and Quality (AHRQ)

Pulmonary embolism resulting from deep vein thrombosis—collectively referred to as venous thromboembolism—is the most common preventable cause of hospital death. Pharmacologic methods to prevent venous thromboembolism are safe, effective, cost-effective, and advocated by authoritative guidelines, yet large prospective studies continue to demonstrate that these preventive methods are significantly underused. Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement practitioners in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, hospital-acquired venous thromboembolism.

Eliminating Disparities to Advance Health Equity and Improve Quality

MHA Keystone Center

The MHA Keystone Center encourages organizations to use this guide to assess the current level of hospital implementation around key strategies aimed at reducing disparities to achieve equity and improving quality. This resource will guide organizations to prioritize and act on identified gaps so that deliberate and purposeful action is taken to ensure that the outcomes across all patient populations are equitable. Sections of the guide include:

Section 1: Understanding Key Terms

Section 2: Why Equity in Care Matters

Section 3: Strategic Pillars on the Journey Toward Equity

Section 4: Recommendations for Action

Section 5: Levels of Implementation

Section 6: The MHA Keystone Center’s Dedication to

Achieving Health Equity

Section 7: Resource Compendium

Managing Acute Respiratory Failure in Small, Rural, and Critical Access Hospitals: Non-Invasive Ventilation & High-Flow Nasal Cannula

IPRO HQIC

Due to medical-surgical nurses’ limited exposure to managing acute respiratory failure, nurses in rural and critical access hospitals do not always have a comfort level with non-invasive ventilation (NIV) equipment and/or High-Flow Nasal Cannula (HFNC). Managing this situation on medical-surgical floors within these smaller hospitals created a void, especially without access to specialty staff who have advanced clinical respiratory experience, lack of critical care beds, and/or the lack of respiratory therapy resources. This is especially true in rural and critical access hospitals, possibly exacerbating adverse events and potentially increasing health disparities (due to access of specialty care issues). This electronic tool provides digestible information to support the front-line in CPAP, BiPAP, and HFNC management.

Opioid Stewardship: IPRO HQIC, Learning and Action Network (LAN)

IPRO HQIC

IPRO Hospital Quality Improvement (HQIC), Learning and Action Network (LAN) webinar on the All-Cause Harm focus are of Opioid Stewardship: April 26th 2021.

IPRO HQIC presented aggregate baseline data on the Opioid Stewardship Hospital Baseline Assessment and heard from a rural hospital on promoting the safe use of opioids (prescribing policy, scripted communication tools, alternatives to opioids, tracking prescribing practices, referral network for pain management, and MAT therapy).

In addition, IPRO HQIC highlight many salient opioid stewardship resources on processes that support the inclusion of patient and family engagement and health equity (stigma) in opioid stewardship efforts. These resources further support IPRO HQIC hospital efforts in All-Cause Harm reduction.

Recording, Slides and All-Cause Harm Resource available.

Modernizing Health Care to Improve Physical Accessibility

Centers for Medicare and Medicaid Services (CMS)

The resources in this inventory include guidance on how to increase physical accessibility of medical services, tools to assess your practice or facility’s accessibility for individuals’ disabilities, and tips and training materials to support efforts to reduce barriers and improve quality of care. This document is intended to provide recommendations on how to improve accessibility in order to improve quality of care for patients with disabilities.