Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA.
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2021-001725.
Clear documentation of instructions for resuming anticoagulant and antiplatelet (AC/AP) medications after gastrointestinal endoscopy is essential for high-quality postprocedure care. Yet, these recommendations are frequently absent, which may impact patient safety. We aimed to improve documentation of postprocedural AC/AP instructions through targeted interventions during outpatient endoscopy at a Veterans Affairs Medical Center using validated Quality Improvement methodology. We identified patients on AC/AP agents presenting for outpatient oesophagogastroduodenoscopy or colonoscopy and found restart recommendations were documented in only 59.4% of procedures at baseline. After two intervention cycles, which included provider education, nursing prompts and alterations to endoscopic documentation software, postprocedure documentation increased by 26.7%-86.1% when compared with baseline (p<0.001). These interventions, which require low-resource utilisation, could be part of standardised processes readily implemented at other institutions to help potentially reduce postprocedure patient confusion, medication errors and complications.
清晰地记录胃肠道内镜检查后恢复抗凝和抗血小板（AC/AP）药物的说明对于高质量的术后护理至关重要。然而，这些建议经常缺失，这可能会影响患者的安全。我们的目标是通过在退伍军人事务医疗中心使用经过验证的质量改进方法，在门诊内镜检查期间进行有针对性的干预，改善术后 AC/AP 医嘱的记录。我们确定了正在接受门诊上消化道内镜检查或结肠镜检查的正在服用 AC/AP 药物的患者，发现基线时只有 59.4%的手术记录了重新开始的建议。在两轮干预后，包括提供者教育、护理提示和内镜记录软件的更改，与基线相比，术后记录增加了 26.7%-86.1%（p<0.001）。这些干预措施所需的资源利用率低，可以作为标准化流程的一部分，在其他机构中轻松实施，有助于潜在地减少术后患者的困惑、用药错误和并发症。
