Your Resource for HQIC News and Learning Opportunities | April 2022
Anticoagulation and Venous Thromboembolism (VTE) Prevention
Anticoagulants are high-risk medications due to complex dosing, monitoring requirements, and inconsistent patient compliance. Use of science-based prevention and treatment strategies ensures the appropriate medication for the indication is selected, as well as the appropriate dose and frequency. This is especially challenging with COVID-19, where patients often suffer from hypercoagulability, and standard prophylaxis is not adequate.1,2

Hospitalized patients with COVID-19 are more likely to survive with anticoagulant therapy.2 Use of prophylactic or treatment anticoagulation for hospitalized patients with COVID-19 was associated with lower in-hospital mortality versus those with no anticoagulation. Only prophylactic dose anticoagulation remained associated with lower mortality at 60 days.3

The American College of Chest Physicians (CHEST) updated guidelines for VTE prophylaxis for hospitalized COVID-19 patients in February 2022. It was noted that critically ill patients should receive standard prophylaxis, moderately ill patients with a low bleeding risk may benefit from therapeutic heparin, and no intermediate dose prophylaxis is recommended for either setting.4
It Figures—Data and Performance
ADE Anticoagulant and VTE Postoperative Rates
Data show both adverse drug event (ADE) anticoagulant and VTE postoperative rates have worsened since the baseline period of 2019 (lower rates are better).

Visit the HSAG HQIC Quality Improvement Innovation Portal (QIIP) to view your ADE Anticoagulant data by selecting the Measure Category of Adverse Drug Events and Measure of ADE Anticoagulant. To view your VTE postoperative data, select the Measure Category of Other Harms and Measure of VTE Postoperative (PSI-12). 
*Rates is per 1,000 admissions. **Rate is per 1,000 surgical discharges.
Source: Medicare Fee-for-Service claims data. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019, and current time period is 12/01/2020–11/30/2021.
The Flash: Resources
The following HSAG resources are available to assist hospitals with anticoagulation safety and VTE prevention.
Anticoagulant Gap Analysis
This gap analysis is a component of a medication management assessment and helps facilities assess areas of anticoagulant protocols, ADE prevention and mitigation strategies, and patient education. 
Anticoagulant Management Roadmap to Success
This roadmap assists facilities in implementing evidence-based guidelines and protocols as an integral part of anticoagulation therapy management to minimize the risk of ADEs.
Thromboprophylaxis Tool
This tool helps facilities assess risk, prescribe treatment, and assess change in condition for VTE.
VTE Roadmap to Success
The VTE roadmap provides strategies to assess VTE risk, standardize care, and mitigate failures.
Critical Communication
Postoperative Sepsis for Elective Surgeries (PSI-13)
This measure has worsened since the 2019 baseline period. The number of infections has increased, while the number of elective surgeries has decreased. Use the Postoperative Sepsis After Elective Surgery Prevention Tool to minimize risk for your patients. This tool covers prehospital strategies, and preoperative and postoperative strategies for the hospitalized patient.
Events and Education
HSAG HQIC Quality and Safety Series
Offered on the 2nd and 4th Tuesdays of the month, these bite-size learning presentations review the key skills necessary for you to function in quality improvement and are intended as a foundation for the novice or as a skills refresher for the expert.
HSAG Care Coordination Series
This series will walk you through the steps for managing avoidable hospital readmissions. Offered on the 1st and 3rd Tuesdays of the month.
HSAG Opioid Stewardship Program
Join HSAG in an action-based quickinar series to provide tactics, strategies, and information needed to implement a successful opioid stewardship program.
References
1 Tremblay D, Dunn AS, Oh WK. A rapid guidance process for the development of an anticoagulation protocol in the COVID-19 pandemic. Wolters Kluwer Public Health Emergency Collection (2021). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462300/.
2 Mazzeffi MA, Chow JH, Tanaka K. COVID-19 associated hypercoagulability: Manifestations, mechanisms, and management. Wolters Kluwer Public Health Emergency Collection. (2021). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7959868/#__sec6title.
3 Vaughn VM, Yost M, Abshire C. Trends in venous thromboembolism anticoagulation in patients hospitalized with COVID-19. JAMA (2021). https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2780927.
4 Moores LK, et al. Thromboprophylaxis in patients with COVID-19. A brief update to the CHEST guideline and expert panel report. CHEST (2022). https://www.sciencedirect.com/science/article/pii/S0012369222002501.
This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-03152022-01