Perform medication reconciliation at all transitions.Use standardized order sets and protocols.Educate staff based on evidence and best practices.The Health Research and Educational Trust focuses on reducing harm related to HAMs by 50% and recommends the following interventions to achieve this goal: The most common anticoagulant errors in acute hospital settings are administration mistakes, including incorrect dosage calculation and infusion rates. All these types of medications are included on the List of High Alert Medications (HAMs) by the Institute for Safe Medication Practices (ISMP) that require special safeguards to reduce the risk of errors or adverse effects. Antiplatelets include aspirin and other aggregation inhibitors such as clopidogrel, and thrombolytics include alteplase (tPA). Anticoagulants include the following drug classes: heparins or unfractionated heparin and low molecular weight heparin (LMWH), warfarin (Coumadin), selective factor Xa inhibitors (rivaroxaban), and direct thrombin inhibitors (dabigatran). This section will discuss medications that affect blood coagulation and includes several types of medications including anticoagulants, antiplatelets, and thrombolytics, as well as their associated reversal agents.Īnticoagulants prevent the formation of a clot by inhibiting certain types of clotting factors. Too rapid administration may cause hypotension or pseudo-anaphylactoid reaction.\).Maximum rate of 5 mg/min, without exceeding 50 mg per 10 min period.Prefer slow IV infusion to direct IV route whenever possible.If shorter than 8 hours since last dose of LMWH:.Administration of antidote may not be necessary check with the Poison Control Center whether administration of low doses of protamine would be appropriate.If longer than 12 hours since the last dose of LMWH:.It may be necessary to repeat the same dose if the APTT remains high when measured 2 to 4 hours after the first infusion.0.5 mg of protamine per mg of enoxaparin or for every 100 anti-Xa units of LMWH.If longer than 8 hours and less than 12 hours since last dose of LMWH:.An additional dose corresponding to half of the initial dose may be necessary if the APTT remains high when measured 2 to 4 hours after the first infusion.
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