Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Anticoagulants are high-risk, needing individualised dosing and monitoring. Practice variation across Queensland hospitals drives need for a stewardship program.
Dates: April 2025 - March 2026
Implementation sites: Metro South HHS
Aim
To establish a multi-site anticoagulant stewardship program aimed at early identification of inpatients at high-risk of anticoagulant-related complications and improving the safety and quality of anticoagulant therapy.
Outcomes
- ~6,000 - 6,500 patients prescribed anticoagulants identified weekly
- ~25% (~1200-1500) of patients prescribed anticoagulants are appropriately stratified for prioritised review
- Total of 1818 interventions within evaluation period (22/4/25-31/1/26)
- Clinician engagement and uptake – 82% of recommendations accepted within 24 hours
- Total of 580 referrals within evaluation period (22/4/25-31/1/26)
- Emerging reduction in anticoagulant-related bleeding (HAC 10.2) with a 15% reduction between Q4 2024/25 and Q1 2025/36
- 8% reduction in heparin 5000units/0.2mL use in the second half of 2025, equal to ~$19,000 in direct medication cost savings and an estimated reduction of up to 197 hours of nursing administration time
Background
Riskman data since 2019-2024 shows there has been:
- Nine primary (confirmed) SAC 1 medication related incidents of which 67% involved anticoagulants.
- 98 primary (confirmed) SAC2 incidents; 23% involved anticoagulants.
Health Roundtable HAC data shows:
- 10.2 - Haemorrhagic disorder due to circulating anticoagulants per 10,000 episodes data: Beaudesert, QEII and PA are above peer group median. Nb PAH is significantly above at 8.7 v. 2.7.bve peer group median.
- 7.1 - Pulmonary embolism per 10,000 episodes QEII and PA are above peer group median. Nb PAH is significantly above at 12.9 v. 6.1.bve peer group median.
- 7.2 - Deep vein thrombosis per 10,000 episodes PA are above peer group median. Nb PAH is significantly above at 11.3 v 4.1.bve peer group median.
Local audits:
- 2783 patient episodes were reviewed, and it was found that heparin therapeutic target is achieved in as few as 23.08% of patients.
Electronic prescribing comparison of outcome pre and post ieMR showed it improved clinical care outcomes for patients receiving anticoagulation, for example, fewer hospital-acquired bleeding complications. However, no significant difference in anticoagulation incidents was identified. Also, ieMR did not statistically altered the rate of toxic pathology results.
Methods
A multi-site, 12-month trial of an inpatient anticoagulant stewardship service was established, leveraging best practices from interstate programs. A customised electronic dashboard was developed to proactively identify patients prescribed anticoagulants meeting high-risk criteria, including supratherapeutic laboratory parameters (INR >4, aPTT >100), use of ≥2 anticoagulants, intravenous heparin infusions, thrombocytopenia (platelet count <50 x10⁹/L), renal impairment (eGFR <30 mL/min), and extreme body weights.
Virtual multidisciplinary rounds, led by advanced pharmacists and senior hematologists, are held three times weekly. Key stakeholder engagement facilitated the establishment of an steering committee and a dedicated venous thromboembolism and anticoagulation subcommittee with multidisciplinary representation across health services. Additional initiatives included the development of localised clinical guidelines and targeted staff education programs.
Discussion
- Resourcing - led by 0.8 FTE haematologist and 1.0 senior pharmacist. However limited by this staffing resource for four hospital sites across Metro South Health.
- Lack of end of bed review, clinical review contingent on good documentation and verbal handover.
- Initiation of an anticoagulant steering committee to support clinical objectives of the service. Representation from all hospitals to improve best practice for anticoagulant management.
- Next steps: secure ongoing funding of the service to collect more safety data and reduction in clinical incidences. Focus on quality initiatives and embed education into the frontline workforce (medical and pharmacy).
References
Bui T, Bortz H, Cairns KA, et al. AAA stewardship: managing high-risk medications with dedicated antimicrobial, anticoagulation and analgesic stewardship programs. J Pharm Pract Res. 2021;51(3):342-7. https://doi.org/10.1002/jppr.1716. 26.
Dreijer AR, Kruip M, Diepstraten J, et al. Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization. PLoS One. 2020;15(6):e0235048. https://doi.org/10.1371/journal.pone.0235048.
Leitinger EJ, Ratnayake N, Taylor S, et al. Anticoagulation stewardship: The new standard of care in anticoagulant safety.
Experiences from a large, tertiary, multicentre health service. Poster presentation at: International Society on Thrombosis and Haemostasis (ISTH) Congress, June 22-26, 2024, Bangkok. Accessed Oct 22, 2024. Available from: https://www.postersessiononline.eu/173580348_eu/congresos/ISTH2024/aula/-PB_993_ISTH2024.pdf. 28.
National Quality Forum. Advancing Anticoagulation Stewardship: A Playbook. Washington, DC: NQF; 2022. Available from: https://acforum.org/web/resource_files/-2022-10-11-115851.pdf.
Alfred Health. Stewardship programs overview. Melbourne: Alfred Health; 2025. Available from: https://www.alfredhealth.org.au/services/pharmacy-at-alfred-health/about-alfred-health-pharmacy/centre-for-medicine-use-and-safety-cmus/cmus-stewardship-programs Bortz H. Anticoagulation Stewardship Program, Alfred Health. Victorian Medicines
Roundtable; 2023. Available from: https://www.victag.org.au/1.2_HB_AH.pdf.
Northern Health. Anticoagulation Stewardship Program overview. Melbourne: Northern Health; 2025. Available from: https://www.victag.org.au/1.2_JN_NH.pdf
Key contact
Vivienne Klyza
Pharmacist Advanced - MSH Anticoagulation Stewardship
Metro South Health