Anemia – Hemorrhage (Health Care / Medication Associated Condition): Clinical and System Reviews, Incident Analyses

​Given the broad range of potential causes of anemia - hemorrhage, clinical and system reviews should be conducted to identify potential causes and determine appropriate recommendations.

Occurrences of harm are often complex with many contributing factors. Organizations need to:

1. Measure and monitor the types and frequency of these occurrences.
2. Use appropriate analytical methods to understand the contributing factors.
3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.
4. Have mechanisms in place to mitigate consequences of harm when it occurs.

To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the Hospital Harm Improvement Resources Introduction.

If your review reveals that your cases of anemia - hemorrhage are linked to specific processes or procedures, you may find these resources helpful:

• Institute for Safe Medication Practices (ISMP). www.ismp.org
• British Columbia. BCGuidelines.ca
• National Blood Authority Australia. Patient Blood Management.
• NATA, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis.
• Thrombosis Canada. Clinical Guides.
• American Society of Health-System Pharmacists (ASHP): Gastrointestinal Stress Ulcer Prophylaxis (pending) https://www.ashp.org/pharmacy-practice/policy-positions-and-guidelines/browse-by-document-type/therapeutic-guidelines
• Stress Ulcers in the Intensive Care Unit: Diagnosis management and Prevention (Weinhouse, 2020) www.uptodate.com
• Institute for Healthcare Improvement (IHI):
  • How-to guide: prevent harm from high-alert medications. 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx
  • Changes: Reduce adverse drug events involving anticoagulants. 2020. http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingAnticoagulants.aspx
  • Anticoagulant tool kit: Reducing adverse drug events & potential adverse drug events with unfractionated heparin, low molecular weight heparins and warfarin. 2008 http://www.ihi.org/resources/pages/tools/anticoagulanttoolkitreducingades.aspx
• Joint Commission - National Patient Safety Goal to reduce the likelihood of patient harm associated with the use of anticoagulation therapy (Joint Commission, 2018).