Identifying, monitoring and reducing preventable major bleeds in the hospital setting

Recent literature describes methods to reduce "preventable" hospital-acquired venous thromboembolism; however, there is a paucity of data on "preventable" bleeding. While risk assessment models exist for both thrombosis and bleeding, these concepts should be differentiated from whether the event was preventable or non-preventable. Here we describe a protocol to identify, monitor, and evaluate anticoagulation-related preventable hospital-acquired major bleeds (PHAMB). This single-center, prospective observational study with retrospective chart review was conducted in 2009 and 2010 to identify anticoagulation-related major bleeding. Eligible anticoagulation-related hospital-acquired major bleeds (HAMB) were further classified as "preventable" or "non-preventable". A total of 229 major bleed episodes were identified of which 188 were excluded due to being community-acquired or non-anticoagulation related major bleeds. Over the 2 year period, five of the 41 HAMB were classified as preventable providing a total incidence of 13 % PHAMB. Three and two of the PHAMB were due to inappropriate dosing and administration of an anticoagulant when contraindications existed, respectively. PHAMB rates decreased from 0.06 in 2009 to 0.04 per 1000 patient days in 2010 (p = 0.62) although this difference was not statistically significant. Raw incidence utilizing Joint Commission methodology demonstrated a 16.7 % rate in 2009 and an 8.7 % rate in 2010. In hospitalized patients, intervention programs may minimize the incidence of anticoagulation-related PHAMB and may maintain similar rates of preventable bleeding over time. Similar programs should be explored prospectively on a larger scale to reduce harm from anticoagulants in the hospital setting.