Implementation evaluation of an inpatient digital dashboard for direct oral anticoagulant surveillance

Purpose

Direct oral anticoagulants (DOACs) are highly effective in the treatment and prevention of thrombosis. Nevertheless, the prevalence of inappropriate DOAC dosing (ie, dosing not in alignment with Food and Drug Administration package labeling) remains high and is associated with suboptimal patient outcomes. Development and utilization of a digital dashboard to support DOAC management in the acute care setting has not yet been described.

Summary

An acute care digital dashboard for population management of DOACs was developed and implemented at 4 acute care facilities, and implementation success was evaluated using qualitative and quantitative surveys completed by lead project clinicians.

Based on responses from all participating facilities related to 7 previously described domains of implementation success, including acceptability, adoption, appropriateness, feasibility, fidelity, penetration, and sustainability, the dashboard implementation was considered a complete success. In 21 monthly dashboard snapshot surveys across all sites, the dashboard identified 1,059 acute care patients receiving DOACs. Of these patients, 96 (9.1%) had a known critical alert, 209 (19.7%) had a possible critical alert, and 77 (7.3%) had a “for your information” alert across all sites.

Conclusion

This case study demonstrated successful implementation of an acute care DOAC dashboard at 4 unique practice sites. Clinicians felt that the dashboard appropriately addressed clinical issues in patients receiving DOACs and was readily incorporated into their daily workflow. Overall, dashboard users were satisfied with the tool and found it palatable.