Improving documentation of anticoagulation and antiplatelet recommendations after outpatient endoscopy

Clear documentation of instructions for resuming anticoagulant and antiplatelet (AC/AP) medications after gastrointestinal endoscopy is essential for high-quality postprocedure care. Yet, these recommendations are frequently absent, which may impact patient safety. We aimed to improve documentation of postprocedural AC/AP instructions through targeted interventions during outpatient endoscopy at a Veterans Affairs Medical Center using validated Quality Improvement methodology. We identified patients on AC/AP agents presenting for outpatient oesophagogastroduodenoscopy or colonoscopy and found restart recommendations were documented in only 59.4% of procedures at baseline. After two intervention cycles, which included provider education, nursing prompts and alterations to endoscopic documentation software, postprocedure documentation increased by 26.7%-86.1% when compared with baseline (p<0.001). These interventions, which require low-resource utilisation, could be part of standardised processes readily implemented at other institutions to help potentially reduce postprocedure patient confusion, medication errors and complications.

Automated summary

Clear documentation of instructions for resuming anticoagulant and antiplatelet medications is crucial for high-quality postprocedure care. However, these recommendations are often missing, potentially impacting patient safety. Through targeted interventions during outpatient endoscopy, we significantly improved the documentation of postprocedural anticoagulant and antiplatelet instructions.