TJC Issues Tips for Managing Direct Oral Anticoagulant Risks

By Jonathan Springston, Editor, Relias Media

The Joint Commission (TJC) has issued a new Sentinel Event Alert regarding bleeding risks for patients who take direct oral anticoagulants (DOACs).

DOACs keep blood from clotting, and stopping bleeding in patients on these medications is more difficult. In fact, TJC notes that DOACs are the second-leading medication involved in error incidents that lead to serious harm or death.

To manage these risks better, TJC stresses more education on and awareness of three points: DOACs have different reversal mechanisms, a reversal mechanism that works for one DOAC may not work for another, and perioperative assessment and communication are essential when assessing bleeding risk.

In addition to learning these points, TJC offers other advice, such as including DOAC indications for use in the patient’s instructions, prescription, and electronic medical record. The agency also encourages healthcare organizations to create and maintain written policies and procedures to identify, respond to, and report adverse DOAC events.

Tthe upcoming September issue of ED Legal Letter will include an in-depth look at the malpractice liabilities surrounding DOAC administration. In the ED, missteps connected to DOACs can lead to lawsuits, including not giving a DOAC to a patient who is indicated for it (or, conversely, taking a patient off a DOAC without explanation) and failing to administer a reversing agent when necessary.

As one attorney who spoke to ED Legal Letter for the story noted, to defend these lawsuits successfully, “solid documentation on the patient’s home medications, last medication dose, medical history, and symptoms is essential.”