ANTICOAGULATION CLINIC

Transcription

1 ANTICOAGULATION CLINIC COMMUNITY MEMORIAL HOSPITAL AND CLINIC BETTY MEIGHAN, RN, BSN SUMNER, IOWA PROGRAM INITIATION Provider request for patient benefit Time factor for physicians in office Significant ADE INR too high CNO willing to incorporate into Cardiac/Pulmonary Rehab department 1

2 EVALUATE PROGRAMS Visited two existing programs Allen Memorial Hospital, Waterloo, IA Pharmacist led program Central Community Hospital, Elkader, IA Nurse led program EDUCATIONAL PROGRAM University of Southern Indiana 6 week online class Certificate of Anticoagulation Therapy Management Cost: $ Book $ No ongoing certification TEXTBOOK Textbook utilized: Managing Oral Anticoagulation Therapy Author Jack Ansell, Lynn Oertek, Ann Wittkowsky 2

3 WORK GROUP Dr. Troy Buchholz, Medical Director Betty Meighan, RN, BSN Barry Westbrook, Pharm. D., Allen Hospital Chris Clayton, Pharm. D., Allen Hospital BEGAN WITH: Policy and procedure development Medical Staff approval of program Program Policy, Procedure and Protocols QI/RM program development Medication verification/accurate medication list Time-in-Therapeutic -Range OPERATIONS Purpose and Goals Scope of Service Referral Process Annual Provider Referral Renewal Admitting and Registering of Patients Process for Patient Care Missed Appointments and Other Absences Medical Record Components Billing for Services Routine Daily Activities CLIA Certification 3

4 ROLES & RESPONSIBILITIES Medical Director for the Anticoagulation Clinic Registered Nurse Role and Responsibility Registered Nurse Privileges PROTOCOLS & GUIDELINES Indications and Goals for Treatment Initiation of Warfarin Therapy Protocol Guidelines for Warfarin Maintenance Dose Adjustment and Monitoring Guidelines for Managing High INR Values PATIENT CARE GUIDELINES Documentation of Patient Visits Initial Patient Assessment and Evaluation Education Established Patient Assessment and Evaluation Discharging Patients 4

5 PROCEDURES CoaguChek XS System Procedure CoaguChek XS Meter Coding CoaguChek XS System Operating and Storage CoaguChek XS Trouble Shooting CoaguChek XS Preventive Maintenance GETTING STARTED Inpatient referral and visit DVT, PE, Atrial Fibrillation, etc. Specialty Referral Post cardiac surgery Office referrals Health Highlight Word of mouth (usually patient driven) PATIENT ACCEPTANCE Appreciate finger stick vs. venipuncture Results immediate One on one with nurse Education reinforced every visit 5

6 PRACTITIONER ACCEPTANCE Saves practitioner and office staff time Better results INR in range longer periods of time Prompt feedback if concerns INR GOAL 63% OR GREATER 2011 Q Q Q Q Q2 INRs w/in Goal Total INRs MED RECONCILIATION Indicator Q 1 12 Q 2 12 Med Rec updated 13/30 70% 8/38 82% Patient received updated med list each med change 13/30 70% 11/35 76% 6

7 WHAT WAS DIFFICULT? Policy and procedure and protocol development while completing regular duties Challenging and hard to manage patients admitted early into program WHAT WAS SURPRISING? Number of patients taking warfarin incorrectly Patients don t understand the numerous things that can impact their anticoagulation status EDUCATIONAL OPPORTUNITIES Utilize teach-back techniques at every session One piece of education new or reinforced at every session 7

8 MOST PROUD Benefit to patients Reduced ADE s CASE STUDIES Mr. A Mrs. H FUTURE FOR PROGRAM Marketing Record and evaluate patient variances Patient satisfaction survey/interview 8

9 NEXT STEP National Certification NCBAP National Certification Board for Anticoagulation Providers CACP Certified Anticoagulation Care Provider Acquire 750 hours practice over 18 months to apply 9