Anticoagulant Safety in Clinical Practice

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nIntroduction

nAnticoagulants are the kind of drug substances that are used to lower the ability of the body to form clots in the blood. They perform this function by limiting the production of vitamin k in the liver hence increasing the time the blood takes to form a clot. They are utilized for the prevention of conditions that are characterized by unusual clotting of blood (Greer, Arber, Glader, List, Means, Paraskevas, Rodgers and Foerster 2014, p. 5). Drugs that are used to prevent blood clotting includes intravenous heparin, which functions by making thrombin to be inactive, and parenteral anticoagulants like warfarin which works by limiting the liver from producing factors that rely on vitamin k that are important for the clotting process. Various types of drugs can be used to prevent formation of blood clots in the body (Edardes 2008, p. 9). Heparin with derivative substances is commonly used to avoid clotting that may pose danger to the health of patients, especially those that have had implants in their hearts. It functions by activating antithrombin III, which is a material in our body system prevents thrombin from agglutinating blood. Another substance utilized in preventing clotting of blood is vitamin K antagonists, which primarily perform their roles by acting as barriers to vitamin k that facilitates coagulation of blood (Kee, Hayes and McCuistion 2012, p. 7). They normally take two to three days to create a full influence thus not recommended for use when an immediate effect is desired. Furthermore, others are taken orally like warfarin, phenindione, dabigatran etexilate as well as apixaban (Turgeon 2004, p. 10). Warfarin disrupts the natural chemical processes of the body system by acting on vitamin k substance, which has a great role to play in the generation of a protein that is found in the blood known as prothrombin. When the generation of vitamin k is reduced, it implies that the generation of prothrombin is slow and therefore long period for a blood clot to be formed.

nCertain indicators necessitate the use of anti-clotting substances. The formation of a blood clot within the deepest side of the vein is a first condition. Several phenomena such as having inability to make movements for a long period, increases the chances of a patient to develop coagulants in the deep veins of the legs, a condition known as deep vein thrombosis. Additionally, heart attack also requires the use of anticlotting substances (Mousa 2004, p. 49). An individual may develop pain in the chest because of blockage to the flow of blood. If the clot totally hinders the flow of blood, it could end up causing a heart attack (Edardes 2008, p. 13). Atrial fibrillation refers to a situation where the atria of the heartbeats in a manner that is not regular and this can result in the formation of a coagulant in the atria that can also migrate to various organs and generate other adverse conditions, which are complex in nature.

nMedical Errors

nErrors that occur during the process of medication are those mistakes committed unintentionally or events that can be avoided during the process of assigning, giving out, administering or evaluating a medicinal substance and form a major avoidable source of undesired effects in the medical practice. They account for 25 percent to 30 percent of the overall mistakes that occurs during the process of medication (Wachter 2008, p. 79). Despite many going unrecognized, latest developments in technology have narrowed into lowering these mistakes during administration (Scully and Cawson 2005, p. 13). These mistakes resulting from medication may not be viewed as harmful despite the injuries it cause to many people annually.

n The most important way to lower the risk of harm of resulting from mistakes that occur during delivery of a health care is to actively participate in personal health care by being aware of the treatment that one takes and the possible outcomes. Treatment mistakes occur in any place for example at home, health facilities, pharmacies and even at the office of a doctor (Scully and Cawson 2005, p. 27). Notably, the common cause is poor communication between the health care personnel and health providers together with their clients. Medical identities that sound alike as well as abbreviations have also resulted in the mistakes.

nAnticoagulant safety issues in clinical Practice

nThe presence of insufficient practice in determining which anticlotting drug to give out to a patient and monitor remain a great challenge to health care institutions. Several factors have been noted to greatly influence these conditions (Schulman 2003, p. 2). The indications, amount, effect and how anticlotting drugs functions are various variables that need keen attention during prescription, dispatching, administering to the client and assessing the impacts of the medication.

nThe utilization of these medicines needs extensive strategies by giving out the dosage and monitoring its effects to minimize threats related to its use so that great patient outcomes can be produced. Lack of proper implementation of professional regulations as well as insufficient competencies of health care personnel influence greatly the outcome of these anticlotting drugs (Wachter 2008, p. 80). The manner in which they are prescribed, administered and monitored is also another aspect. These are hugely caused by failure of the local to either audit anticlotting drugs service in an effective manner or to take action on the outcomes of the audit in order to improve the clinical care.

nAnother factor that contributes to mistakes committed during anticlotting drug therapy is the incorrect prescription of the amount of these drugs. In most cases, healthcare workers come up with assumptions of patient information without using the recommended ways, such as estimating the weight of a patient before administering a dosage instead of weighing the patient using a standard machine to get the exact value to work on (Rosette and Gill 2005, p. 9). Poor recording of outcomes after anticlotting drugs has been administered have been found to be significant. These results are normally required according to the policy for the rate adjustments of the anticlotting drugs. Furthermore, many patients possess complicated conditions that necessitate them to take other medications (Osheroff 2009, p. 11). Failure of the healthcare professionals to establish this information can result in adverse medical outcomes.

nAnticlotting drugs taken orally interact with a wide range of other commonly prescribe drugs such as antibiotics and analgesics and this may increase the impacts of the anticlotting drug. This may also result to unconsidered co-prescribing or even drug counteraction. The amount of anticlotting drug given out to a patient is another aspect put into consideration in its administration, such warfarin (Lee, Lee, Kim, Lee, Choi and Cho 2007, p. 5). Its provision in more than strength has the possibility of adding the potential risks of overdose and therefore needs an additional step of educating the patient particularly in older people. Poor documentation of the reason as well as the treatment plan during the initial stages of anticlotting therapy also plays a role in mistakes that are encountered (Camire, Moyen and Stelfox 2009, p. 91). This will result to poor and insufficient clinical auditing of anticlotting drugs hence leading to errors.

nAdditionally, safety checks that are not sufficient at repeat prescriptions and dispenses that are repeated contributes to the errors committed administration of anticlotting substance therapy. Potential confusion has also been noted that arise from different strength tablets that are normally presented in coded packs that are colourless (Kitchens, Kessler and Konkle 2013, p. 23). The client seeking medical care safety alert offers advice to various institutions dealing with health to ensure that appropriate measures are put in place to control the potential risks that are associated with the prescription and administration of anticlotting substances. These anticlotting substances form one of the categories of drugs that are mostly recognized as resulting to avoidable harm in addition to being admitted in the health facility (Charney 2012, p. 9). Institutions dealing with the provision of health care should therefore ensure that their staffs are properly trained on how to curb these mistakes that frequently takes place within their settings, and should it happen, the necessary action or remedy to take.

n These institutions also need to review and develop up to date written guidelines and procedures to make sure that they make a reflection of what is required as a safe practice. Furthermore, they need to make regular auditing of anticlotting services by incorporating indicators as part of yearly medicine management, audit project (Hall and Harpenau 2013, p. 48). Another aspect that health care institutions need to do is to make sure that the people seeking medical care that are prescribed with anticlotting substance receive appropriate and adequate information regarding these medicine (Byers and White 2004, p. 10). There is also the need to ensure safety practice for those who prescribe and dispense to ensure that the patient’s blood clotting is monitored frequently.

nInstitutions dealing with health care further need to make sure that the specialists who are concerned with dental management treat their clients as per the guidelines of therapy based on the evidence. In addition, there is need by these institutions to make changes in the domestic regulations that will ensure that the ranges of anticlotting products that are used are up to the standards. This involves incorporating features, which promote its safety during use (Clarke and Ketchell 2011, p. 5). The health institutions additionally need to promote the usage of safety practice guidelines that have been written down that stipulates how anticlotting substances should be administered in social care settings.

nThere exist various centers that ensure that the medication across different institutions offering healthcare is up to standards. The Institute of Safe Medication Practices (ISMP) has identified crucial aspects that have huge influence on the use of medication, emphasizing that shortcomings in these elements can result to mistakes being committed during the process of medication (Lip, Larsen, Skjøth and Rasmussen 2012, p. 91). These key variables include information by the patient as well as information of the drug, adequate communication between not only health personnel but also between health care workers and patients too (Charney 2012, p. 12). Another aspect identified is that of proper packaging of the drug and ensuring that it is properly labeled, safe storage and distribution of medicinal drugs, device for acquiring drugs, forces within the environment as well as education and competency of the medical staff.

nFurthermore, education of the patient plays a key role as well as the high standards quality and the management of risks. The National Patient Safety Agency (NPSA) leads and participates actively in ensuring that the patient care is improved by informing and offering support as well as affecting the health industry (Kee, Hayes and McCuistion 2012, p. 13). This agency came into being in 2001 with the main purpose of overseeing incidences involving the safety of the people seeking health care in health institutions incorporating reporting mistakes that arises during both medication and prescription. It also monitors the safety element of hospital designs and sanitation and food (Husted 2005, p. 1). Apart from ensuring that there is reporting of incidences involving medication in the earlier stage, the National Patient Safety Agency targets to spearhead a culture that is both open and fair in health facilities and across the service of health, therefore encouraging doctors and other staffs within health setting to make sure that incidences are reported.

n Another center that plays huge role in ensuring safety in health care is the Joint Commission International (JCI). This agency works to make better both the safety of the patient as well as the quality of care offered in health institutions in international cooperation. It achieves this through education it offers, publications they make, advisory services and also accreditation and award of certificates (Lip, Larsen, Skjøth and Rasmussen 2012, p. 91). It collaborates with various hospitals, clinics, centers for academics, systems and institutions of health, and cross border advocates to spearhead strong standards of cases as well as providing remedies that, aim at ensuring high-level performance is attained.

nThe Center for Drug Safety is also another agency dealing with safety of the medication process. It functions to raise the level of public health by promoting marketing of medications that are safe, through the formulation and use of pharmacoepidemiology and pharmacovigilance research, and to offer education on best ways to identify, evaluate, oversee and reduce risks as much as possible. It formulates and evaluates new ways for monitoring drugs and other biological on a population (Camire, Moyen and Stelfox 2009, p. 10). Additionally, it provides graduate and on-going education to the professionals concerning safety of drugs and monitoring its use. It also expands various groups of professionals or experts in research concerning safety of drugs through extensive training and new researches.

nIt informs new ways of enhancing both the drug safety and management of risks to inform regulations and practice. Another center that enhances the safety of medications is the Medication Safety and Efficacy Center (MSEC). This agency focuses on raising the level of safety of drug use and its ability to achieve the desired outcomes (Compton, Fanjiang, Grossman and Reid 2005, p. 4). It also deals with reducing mistakes committed during the treatment process by pinpointing the situations and the magnitude of the adverse drugs events, which take place with both prescribed and non-prescribed drugs.

nThe Centre for Pharmacoepidemiology and Drug Safety (CPDS) was developed in 2004 and it functions to conduct high standards research to give information to policy formulations concerning practices that enhances health and the working and management of healthcare (Ercan, Bostanci, Ozer, Ulas, Ozogul, Teke and Akoglu 2009, p. 5). This center leads in research work through conducting studies that are authoritative on the use of prescribed drugs, the comparative effectiveness and safety of a drug in practical setting of a clinic.

nTheir area of specialization is in application of research on medicine usage and safety, as well as regulations and project monitoring of pharmacological institutions and creative services, which involves specialized personnel in pharmacology. The Center for Safe Medication Practice and Research (CSMPR) deals with the unfriendly effects of drugs that form a probable threat to a patient. This research center was established in conjunction and association with both local and international bodies (Dager, Gulseth and Nutescu 2011, p. 10).

nThe core aim of the center is to promote health and life quality of those seeking medication through collaboration among various research disciplines that find out solutions to diverse questions concerning safety during administration of a health service. International Medication Safety Network (IMSN) is another center that deals with promoting safety during treatment services (Lewis, Heitkemper and Dirksen 2004, p. 101). It is an international network of developed safe treatment exercise centers, which run programmes that reports mistakes committed during treatment process and come up with procedures that seeks to minimize harms that can be prevented from the utilization of medicine in practice.

nInternational Medication Safety Network facilitates treatment exercise that is void of harm in order to improve the safety of the patient across nations. This center came into existence in 1994 as an organization for offering charity until 2008 when it resumed into whole exercise of the reporting program (Lewis, Heitkemper and Dirksen 2004, p. 81). Moreover, Patient Safety Translational Research Center (PSTRC) strives to put together achievements in basic research, which possess ability to be related to patient safety into a research setting that can be applied.

nIt brings together a wide variety of research disciplines. They carry out research to propel improvements in the safety of the patients. Such researches help in transforming into benefits for individuals such as lowering prescription mistakes, improving the diagnosis of diseases as well as bringing down accidents in the surgery process (Barash, Cullen and Stoelting 2006, p. 13). The National Pharmacovigilance and Drug Safety Center (NPDSC) are concerned with identifying, evaluating and preventing the occurrence of an adverse effect from the use of a drug (Greer, Ginsberg and Forbes 2007, p. 4). It pinpoints predisposing factors and likely methods that underlie undesired effects. It also conducts monitoring of quality of data and encourages rational use of drugs and in a safe way.

nConclusion

nAvoiding mistakes during medication needs vigilance and the use of technology in a right manner to helps ensure that right guidelines are adhered to. Physicians’ orders via computers minimizes mistakes by pin-pointing and informing physicians to patients interaction of drugs, hence removing prescriptions that are written in a poor way, and helping give support via decisions on dosing regiments that are up to the standards. There is also the need to utilize practices that are safe which are found in a health institution by health personnel. This also calls for elimination of distractions when preparing and formulating medications for a patient (Lewis, Heitkemper and Dirksen 2004). Finally, it is also important to single out the role of fatigue in enhancing mistakes during medications.

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