Assess use of anticoagulants to meet new NPSG requirement

Have a policy that addresses precautions for blood thinners

With one death every day and about 1.3 million people injured annually due to medication errors,1 it is no surprise that reducing the risk of patient injury due to medication error is a National Patient Safety Goal for The Joint Commission.

While Goal 3 — "improve the safety of using medications" — has always been a safety goal, it is regularly reviewed and requirements for meeting the goal are adjusted as needed, says Peter B. Angood, MD, vice president and chief patient safety officer for The Joint Commission. The 2008 addition to Goal 3 is requirement 3E, which states that organizations must "reduce the likelihood of patient harm associated with the use of anticoagulation therapy."

"This topic [anticoagulation therapy] has surfaced in our Sentinel Events Advisory Group's reviews quickly in the past couple of years," says Angood. "Anticoagulation therapy can be safe for patients if they are monitored carefully by their primary care doctor and their home health provider to make sure that the correct dose is taken."

Unlike new goals in previous years, requirement 3E must be implemented within a specific timetable, says Angood. "In past years, we have identified a goal and given organizations one year to prepare for implementation," he says. The one-year time frame gave organizations a sense that there was no need to do anything for one year, he admits. The checkpoints outlined in the rationale for requirement 3E call for: assignment of leadership responsibility by April 1, 2008; implementation work plan in place by July 1, 2008; pilot testing in at least one clinical unit by Oct. 1, 2008; and full implementation by Jan. 1, 2009. "These checkpoints should help organizations better prepare for full implementation," he adds.

"I don't anticipate any problems complying with this patient safety goal," says Sharon Darnall, RN, director of Marion Home Health Services at Crittendon Health Systems in Marion, KY. "We care for a lot of post-surgical orthopedic patients so we have to monitor them carefully," she says. Because many of these patients had to discontinue anticoagulants prior to surgery, knowing when to restart anticoagulation therapy and making sure the patient understands medication instructions is already an important part of the nurses' responsibility, she adds.

The main issue for home health agencies will be the need to establish guidelines for the monitoring and management of patients on anticoagulant therapy, says Angood. "The agency will need to define the management process, establish protocols for baseline and ongoing monitors, and define the process for identification of problems and solutions to those problems," he says. The key to continuous compliance will be staff and patient education, he adds.

Requirement 3E is the only new addition to The Joint Commission National Patient Safety Goals for home health programs for a reason, Angood points out. "We are aware that new goals or new requirements create a need for our accredited organizations to re-evaluate systems and procedures," he says. "Our field review demonstrates that organizations are coming up to speed on the goals, so we eased off on the number of new goals that organizations must address in 2008."


1. Food and Drug Administration. "Medication errors." Accessed at


For more information about meeting the anticoagulation therapy requirements of National Patient Safety Goal 3, contact:

  • Joint Commission Standards Interpretation Group, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181. Phone: (630) 792-5900. Web: To submit a question by e-mail, under "Standards," click on "Standards FAQs." Select "Click here to go to the Standards Online Question Submission Form."

To see a copy of the 2008 National Patient Safety Goals and implementation expectations, go to the web site. Select "Patient Safety" on the top navigation bar, then choose "National Patient Safety Goals." Select "Home Care" to see the goals. Links to the appropriate chapters that describe the rationale and implementation expectations are at the top of the page.

For information about anticoagulation therapy and tools you can use, go to:

  • ClotCare Online Resource: Provides information for clinicians and patients/caregivers on anticoagulation topics such as warfarin, anticoagulant medications, blood clots, DVT, PT, INR, cancer, thromboembolism, atrial fibrillation, and antithrombotic therapy.
  • Institute for Clinical Systems Improvement (ICSI): ICSI has developed an evidence-based Anticoagulation Therapy Guideline Supplement and a Venous Thromboembolism Guideline. The supplement provides recommendations regarding the indications and contraindications, adverse effects, dosing, monitoring of anticoagulant drugs, correction of supratherapeutic dosing of anticoagulants, and information on bridging therapy. The guideline is a resource for the diagnosis and treatment of venous thromboembolism including deep vein thrombosis of the lower extremities and pulmonary embolism.
  • The University of Utah Pharmacy School has developed a list of Internet resources for anticoagulation therapy information, guidelines, and education. Go to: