MAQI² DOAC Dashboard Going Nationwide

As many as 20% of patients receive the wrong dose of direct oral anticoagulants, or DOAC, when they are initially prescribed due to numerous factors influencing treatment for blood clots. When DOACs are dosed incorrectly, patients are at a higher risk for costly and potentially fatal complications including bleeding, clotting and stroke.

The most common DOAC prescribing errors are failures to adjust the dose in accordance with the patient’s other clinical conditions, such as kidney or liver disease, and failures to identify potential reactions to other medications the patient is taking.

To address these potentially deadly mistakes, the Michigan Anticoagulation Quality Improvement Initiative, or MAQI², developed a DOAC Dashboard in 2020 that can scan a health system, hospital or group practice’s patient population for DOAC dosing errors. The initial dashboard was created for the Epic electronic medical record system and implemented in four Michigan hospitals: Michigan Medicine, Henry Ford Health, Beaumont Health and Spectrum Health. Each hospital has a designated nurse or pharmacist that regularly reviews the dashboard and contacts prescribing providers to inform them of dosing concerns and help coordinate dose changes.

“Most providers are very appreciative of the dashboard,” said MAQI² Program Manager Brian Haymart. “They’re extremely busy taking care of patients, so this added layer of monitoring is really helpful in catching safety concerns quickly.”

During a four-month period at one of the participating hospitals, pharmacists contacted 271 prescribers about dosing errors.  In 79% of these cases, some form of intervention occurred: 59% increased or decreased DOAC dose, 12% changed the anticoagulant or discontinued an interacting drug, and 29% ordered labs to recheck renal function.

Now MAQI² is receiving requests from hospitals all over the country for help implementing a similar dashboard. In response, the MAQI² team plans to develop a universal version of the dashboard that will allow for more efficient expansion to other hospitals.

“Expert nurses and pharmacists working in anticoagulation clinics benefit immensely from well-designed tools that help them in their anticoagulation stewardship activities,” said MAQI² Program Director Geoffrey Barnes, M.D. “The DOAC Dashboard was designed to help these clinicians work more efficiently and have greater impact to ensure that patients who take anticoagulant medications get the safest possible care.”

The MAQI² team hopes to expand the dashboard to other hospitals in 2024. Interested parties can contact Brian Haymart for more information: khaymart@med.umich.edu.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.