Hospital Self-Assessment for Anticoagulant Safety Instructions

Establish a multidisciplinary team that will work on completing sections or all of the survey. This team can include:

  • Senior administration Representative
  • Risk management and/or quality improvement professional
  • Staff nurse
  • Staff pharmacist
  • Staff physician

Your team should be provided with sufficient time to complete the self-assessment and charged with responsibility to evaluate, accurately and honestly, the current status of anticoagulant safety practices in your facility. There may be items that do not apply to your institution or items which are not yet strategies or practices at your facility. The value and accuracy of the self-assessment is greatest when completed by a multidisciplinary group.

We suggest that if you divide the work among individuals that you schedule at least one meeting of about one to two hours to complete the self-assessment.

Before the self-assessment begins, have everyone read and review the survey in its entirety. The copyright allows you to make copies of the self-assessment for internal use.

Complete the "Demographic Information" form.

Discuss each current strategies and practices and evaluate the hospital's current success in implementing the self-assessment items.

As necessary, investigate and verify the level of implementation for each item with other health care practitioners outside the team.

When a consensus on the level of implementation for each self-assessment item has been reached, mark one of the following choices next to each item (the responses can later be entered into the ISMP Canada website, Please note that the rating scales for the two categories differ slightly.

The category of strategies is rated using the scale:

  1. A There has been no activity to formally discuss this strategy or intervention
  2. B This strategy or intervention has been discussed but there has been no activity to implement
  3. C This strategy or intervention is developed but not yet routinely utilized
  4. D This strategy or intervention is fully implemented and part of routine practice
  5. NR Not relevant to my hospital

While the category of practices is rated on the following scale:

  1. A There has been no activity to make this part of routine practice
  2. B This practice is routine for a small proportion (< 25%) of patients
  3. C This practice is routine for some (25-50%) patients
  4. D This practice is routine for most (50-90%) patients
  5. E This practice is routine for all patients
  6. NR Not relevant to my hospital

There is a weight associated with the evidence behind each of the self-assessment questions. Your total score will be calculated based on the implementation of the evidence-based best strategies and practices in our facility.

For self-assessment items with two distinct elements, each separated with the word "OR" and labelled (a) and (b), answer either part (a) or part (b), but not both.

Take advantage of the web-based program, which allows comparison with results of other respondents on both a national and regional basis. (If you have completed more than one self-assessment, these results can be compared on-line.) Once the self-assessment has been completed on paper e-mail to obtain a password.

Submit data from the completed self-assessment to ISMP Canada electronically through our secure web site ( The Hospital Self-Assessment for Anticoagulant Safety page has a tab entitled Enter Survey See Results. On this page is the field to enter your password and access the HSASAS.

The special, web-based survey tool will immediately download the information into a database maintained solely by ISMP Canada. No data will be maintained on the Internet survey form after it has been submitted. Confidentiality is assured. The aggregate findings may be used for research and education purposes only.