|Title:||Revision of the Adult WA Anticoagulation Medication Chart (WA AMC)|
|Document ID:||Operational Directive OD 0522/14|
|Date of issue:||Wednesday, 21 May 2014|
|Description:||An anticoagulation medication chart has been available for use in Western Australian hospitals since mid-2007. The WA Anticoagulation Medication Chart (WA AMC) was originally developed by a multidisciplinary working group of the WA Medication Safety Group (WAMSG) and was designed to standardise and replace the anticoagulation charts in use across WA hospitals.|
|Framework:||Clinical Governance, Safety and Quality Policy Framework|
|Period of effect:||from 31 January 2014 to 31 January 2017|
|Authorised by:||Professor Bryant Stokes, A/ Director General, Department of Health Western Australia, 02-May-2014|
|Print version:||View print version|
Revision of the Adult WA Anticoagulation Medication Chart (WA AMC)
An anticoagulation medication chart has been available for use in Western Australian hospitals since mid-2007. The WA Anticoagulation Medication Chart (WA AMC) was originally developed by a multidisciplinary working group of the WA Medication Safety Group (WAMSG) and was designed to standardise and replace the anticoagulation charts in use across WA hospitals.
In 2012 a process of chart revision was undertaken by the Quality Improvement and Change Management Unit (previously known as the Office of Safety and Quality in Healthcare), Performance, Activity and Quality Division, in consultation with the WA Anticoagulation Steering Committee. The chart was redesigned to mitigate risks identified with the use of the chart to date.
The changes on the chart include:
The remainder of the chart is to be used as before.
This operational directive specifies the use of the WA AMC for the prescribing and administration of all anticoagulants in all WA Public hospitals excluding PMH.
The WAAMC is to be used in conjunction with the adult (non-paediatric settings) National Inpatient Medication Chart (NIMC). The WAAMC is mandated for use to prescribe and administer all anticoagulant medications in all non-critical care areas. Use of the WA AMC is recommended within critical care areas, where this is practicable.
The WA AMC caters for the prescription and administration of anticoagulant medications, including low molecular and unfractionated heparins, warfarin and new oral anticoagulant agents.
The WA AMC is not to be used for the prescribing and administration of antiplatelet or other antithrombotic agents. Concomitant use of these agents must be clearly documented by the medical team on the WAAMC in the PRE-PRESCRIPTION SCREEN on the front page of the WAAMC.
The WA AMC is not to be used for prescribing or monitoring the use of mechanical prophylaxis.
While use of the chart for prescribing and administering anticoagulant medications is mandated, dosing guidelines contained within the chart are recommendations only. These do not cover all clinical scenarios and do not replace the need for clinical judgement.
The WA AMC Version 7 should be in use all WA public hospitals as early as practical, no later than 31 July, 2014. A number of resources are available to assist with implementation of this version of the WAAMC and these are available on the Office of Safety and Quality in Healthcare website. http://www.safetyandquality.health.wa.gov.au
Use of ancillary charts
It is recognised that missed doses may be an unintended consequence of the use of ancillary/ specialised medication charts. For this reason it is imperative that the current national NIMC for the patient is appropriately annotated on the front of the chart and on the inside left page on the “Anticoagulation in Use” tick box to indicate the use of the WA AMC.
Artwork for the chart (HP 10744) is available through the Quality Improvement and Change Management Unit and with the printing company tendered to print medication charts for WA Health through the Health Corporate Network. (Currently Print Media Group in 2014).
Most important is the need for each Health Service to insert the aPTT therapeutic ranges and the aPTT nomogram range cut-offs. All other changes in layout and content must be made at the state level. It is recommended that the following system be used to indicate the version.
VERSION NUMBER 000_AAA###_MMYY where,
If an individual Health Service needs to modify the hospital specific aPTT ranges in response to changes in equipment or processes at individual laboratories. These changes should be reflected locally in the version number of chart.
Recommending a change in the WA AMC
Recommendations for change of the WA AMC can be made via email to email@example.com
Recommendations for change must be evidence based, with the primary objective of improving patient safety.
Health Services should monitor compliance against the features of the chart in terms of completion of appropriate sections. Dosing and monitoring recommendations are to be applied at the discretion of the medical staff and do not replace clinical judgement.
Professor Bryant Stokes
This circular last updated: Wednesday, 21 May 2014 at 1:18pm