Actions that can make anticoagulant therapy safer: Alert and other information

This Patient Safety Alert advises healthcare organisations to take steps to manage the risks associated with the prescribing, dispensing and administering of anticoagulants.

Anticoagulants are one of the classes of medicines most frequently identified as causing preventable harm and admission to hospital.

Healthcare organisations in England and Wales should:

1. Ensure staff are properly trained.
2. Review and / or update written procedures and clinical protocols to ensure they reflect safe practice.
3. Audit anticoagulant services using BSH/NPSA safety indicators as part of the annual medicines management audit programme. 
4. Ensure that patients prescribed anticoagulants receive appropriate information. 
5. Promote safe practice for prescribers and pharmacists to check that patients’ blood clotting (International Normalised Ratio, INR) is monitored regularly and that the INR level is safe before issuing or dispensing repeat prescriptions for oral anticoagulants.
6. Promote safe practice for prescribers co-prescribing one or more clinically significant interacting medicines for patients already on oral anticoagulants: arrange for additional INR blood tests and inform the anticoagulant service that an interacting medicine has been prescribed.
7. Ensure dental practitioners manage patients on anticoagulants according to evidence-based therapeutic guidelines. 
8. Amend local policies to standardise the range of anticoagulant products used, incorporating characteristics which promote safer use.
9. Promote the use of written safe practice procedures for the administration of anticoagulants in social care settings.

Resources listed below:

• Patient Safety Alert
• Template service audit form
• Information for community pharmacists, GPs and social care providers
• Poster for dental practices on how to manage patients who are taking warfarin and undergoing dental treatment
• British Society of Haemotology Standards for anticoagulants
• Risk assessment reports

See also:

• Anticoagulant therapy - information for patients and carers
• Anticoagulant therapy - work competences