nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 1 Background Background

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1 Keeping Our Patients Safe with Patient Education for Anticoagulation Therapy NICHE Conference Jean-Marie Nacer MSN, RN April 16, 2015 Background September of 2008: The Joint Commission issued a Sentinel Event Alert warning that brought attention to an increase in patient accidental deaths and overdoses associated with the use of anticoagulants in the United States. It was recognized that these events can be prevented with increased communication between healthcare providers and patients. 2 Background This evolved into a National Patient Safety Goal which focuses on key elements to reduce the harms of anticoagulation medication. 3 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 1

2 Background Atrial fibrillation(af) is a major indication for oral anticoagulant usage. The incidence of (AF) increases with age Half of all patients with (AF) are age 75 or older (Hua, et al., 2011). The use of Vitamin K antagonists (VKA) is associated with an annual increase in major bleeding risk of % and intracranial hemorrhage of 0.2% (Majeed & Schulman, 2013). Insufficient adherence and low level of patient knowledge about anticoagulants are the primary causes for complications (Hua, et al., 2011). 4 Background Anticoagulant use coupled with increased fall risk: Annually, one third of all older adults ages 65 or older sustain a fall (CDC, 2014). Among older adults, falls are the leading cause of both fatal and nonfatal injuries (CDC, 2014).. 5 Background Our medical center identified the need to improve our compliance with providing education to our patients regarding the harms associated with anticoagulant therapy. Identified innovative ways to provide this education with our new technology. Patient Education Technology Communication Patient Safety 6 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 2

3 Purpose The purpose of our initiative is to protect the safety of our patients by improving our compliance with informing them about the harms associated with their anticoagulation therapy. 7 Where we started January 2013 Re-opened after Hurricane Sandy New Electronic Medical Record in place 8 Where we started Early 2013 Process involved receiving 30 charts/month from Food & Nutrition Department Only included patients who were taking Warfarin Retrospective review Limited number of charts Was not meeting our Regulatory Reporting needs 9 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 3

4 March 2013 Found there was an inconsistency in documentation of patient education for the harms associated with anticoagulation therapy Explored the education options available in our new EMR for anticoagulation patient education. Developed education with screen shots as reference materials for staff Sent out to Nurse Managers and staff nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 4

5 13 April 2013 Staff education of required teaching components and documentation completed at monthly Nurse Practice Council Monitoring sample size continued to be too small 14 June 2013 Meeting held with Pharmacy and EPIC reporting team to discuss the audit process and possibility of obtaining reports Regulatory Department recommended to monitor additional anticoagulants, rather than just Warfarin. Requested a monthly report from EPIC to monitor compliance identified that we would start to track both Lovenox and Warfarin 15 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 5

6 August 2013 Report built Captured 100% of patients discharged on Warfarin and Lovenox 16 September 2013 Report build changed to include all possible Anticoagulants (9/30/13) Compliance reported by unit-level detail Anticoagulation Patient Education- September 2013 Tisch Inpatient Units Numerator DenominatorCompliance 12 East % 12 West % 13 East % 13 OB % 14 East % 14 TPU % 14 West % 15 East 15 West % 16 BMT 0 1 0% 16 East % 16 Observation % 17 East % 17 West % 8 West/East 0 1 0% 9 East % HCC % HCC % HCC % HCC % nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 6

7 October 2013 Educators & Quality Specialists rounded on patient care units to educate staff on NPSG requirements and documentation requirements. Question regarding anticoagulation patient education added to our internal Mock Joint Commission Tracer Tool Quality Specialists requested change to Electronic Medical Record to help facilitate a reminder for staff to complete the education/documentation. Reporting on all Anticoagulants 19 November 2013 Results reviewed with Senior Directors of services Start to obtain unit-specific action plans in areas not meeting compliance Continued education and re-education of nursing staff on process/rationale to complete anticoagulation patient education and documentation Peer to peer education 20 Results 21 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 7

8 Conclusions/Implications Staff education regarding the importance of patient/family education Use of technology to aid staff teaching Use of technology to monitor compliance outcomes The innovative use of technology and education can help staff to be more adept to protect the safety of patients by improving their efforts to inform patients about he harms associated with their anticoagulation therapy. 22 References Centers for Disease Control and Prevention (CDC) (2014). Falls Among Older Adults: An Overview. Retrieved from Hua, T., Vormfelde, S., Abed, M., Schneider-Rudt, H., Sobotta, P., Friede, T., & Chenot, J. (2011). Practice nursed-based, individual and video-assisted patient education in oral anticoagulation- Protocol of a cluster-randomized controlled trial. BMC Family Practice, 12:17. Retrieved from Majed, A. & Schulman, S. (2013). Bleeding and antidotes in new oral anticoagulants. Best Practice & Research Clinical Haematology, 26. Retrieved from 23 Questions? Jean-Marie Nacer MSN, RN Nursing Quality Specialist Jean-Marie.Dillon@nyumc.org Presentation Title Goes Here 24 nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership 8