Te hōtaka whakahaere rongoā ārai poketoto
Anticoagulation stewardship
In September 2022, Te Tāhū Hauora started a collaborative as part of an effort to reduce the number of adverse events related to the use of anticoagulants.
The aim was to develop a national package of interventions to implement across Aotearoa New Zealand for the safer use of anticoagulants.
The approach has now changed from a specific intervention package to stewardship. The difference between this and the original approach is that stewardship involves continuous improvement.
The Institute for Healthcare Improvement classes anticoagulants as one of four groups of medicines (along with opioids, insulins and sedatives) that can cause harm to patients, even when used as intended. All anticoagulants are associated with bleeding, and some events are unavoidable. However, many adverse events can be avoided if appropriate protocols and procedures are used.
Seven hospital-based teams who expressed an interest in improving anticoagulant management have been working on various projects. The teams identified the opportunity for improvement and related interventions. These interventions were tested to make sure they could be adapted to local needs. Te Tāhū Hauora provided advice and education on various aspects of quality improvement, including the use of quality improvement tools.
Consumers with lived experience have been involved since the project began and provide vital insight into the changes required for safer anticoagulant use.
We are now focusing on stewardship. Our approach is based on the model developed in the USA and has been implemented in several US hospitals.
The stewardship approach has four Aotearoa New Zealand-specific elements:
- commit to local and national governance and leadership
- improve knowledge and skills for consumers, whānau and clinicians
- monitor and report on measures
- improve clinical processes and practices.
The principles underlying the anticoagulation stewardship programme include equity (with specific attention to Te Tiriti o Waitangi and Māori health) and consumer partnership guided by the code of expectations for health entities’ engagement with consumers and whānau.
Te Tāhū Hauora will continue to provide project management, quality improvement and stakeholder engagement to support the development and testing of the programme, ready for implementation in 2024–25.
Phase one: July–September 2023 (complete)
- Transitioned programme to stewardship approach
- Considered testing approach
- Confirmed clinical leadership
Phase two: October–December 2023 (complete)
- Continued developing package resources
- Developed testing approach
- Established advisory groups
Phase three: January–April 2024
- Finalise package
- Establish test site teams
- Begin testing phase in late February
- Publish webpages and consumer videos on Te Tāhū Hauora website
Phase four: May–June 2024
- Testing phase ends
- Receive feedback from test sites
- Review data and revise package
Phase five: July–December 2024
- Launch package
- The safer use of anticoagulants | Te hōtaka whakahaere rongoā ārai poketoto: case for change
- Literature review:
- Anticoagulation stewardship programme diagram
- Consumer stories:
More resources will be made available as they are completed and tested.
Background
The Institute for Healthcare Improvement classes anticoagulants as one of four groups of medicines (along with opioids, insulins and sedatives) that can cause harm to patients, even when used as intended. All anticoagulants are associated with bleeding, and some events are unavoidable. However, many adverse events can be avoided if appropriate protocols and procedures are used.
Seven hospital-based teams who expressed an interest in improving anticoagulant management have been working on various projects. The teams identified the opportunity for improvement and related interventions. These interventions were tested to make sure they could be adapted to local needs. Te Tāhū Hauora provided advice and education on various aspects of quality improvement, including the use of quality improvement tools.
Consumers with lived experience have been involved since the project began and provide vital insight into the changes required for safer anticoagulant use.
Current approach – stewardship model and project timeline
We are now focusing on stewardship. Our approach is based on the model developed in the USA and has been implemented in several US hospitals.
The stewardship approach has four Aotearoa New Zealand-specific elements:
- commit to local and national governance and leadership
- improve knowledge and skills for consumers, whānau and clinicians
- monitor and report on measures
- improve clinical processes and practices.
The principles underlying the anticoagulation stewardship programme include equity (with specific attention to Te Tiriti o Waitangi and Māori health) and consumer partnership guided by the code of expectations for health entities’ engagement with consumers and whānau.
Te Tāhū Hauora will continue to provide project management, quality improvement and stakeholder engagement to support the development and testing of the programme, ready for implementation in 2024–25.
Proposed timeline
Phase one: July–September 2023 (complete)
- Transitioned programme to stewardship approach
- Considered testing approach
- Confirmed clinical leadership
Phase two: October–December 2023 (complete)
- Continued developing package resources
- Developed testing approach
- Established advisory groups
Phase three: January–April 2024
- Finalise package
- Establish test site teams
- Begin testing phase in late February
- Publish webpages and consumer videos on Te Tāhū Hauora website
Phase four: May–June 2024
- Testing phase ends
- Receive feedback from test sites
- Review data and revise package
Phase five: July–December 2024
- Launch package
Resources
- The safer use of anticoagulants | Te hōtaka whakahaere rongoā ārai poketoto: case for change
- Literature review:
- Anticoagulation stewardship programme diagram
- Consumer stories:
More resources will be made available as they are completed and tested.
Contact us
If you need more information or are interested in being involved, please contact the team at anticoagproject@hqsc.govt.nz.
Published: 9 Feb 2024
Modified: 1 Oct 2024
