Anticoagulation Laurel Newman Quality implementation Manager - - PowerPoint PPT Presentation

Anticoagulation

Laurel Newman Quality implementation Manager Primary Care Clinical Program

• 1. Clinical program strategy for 2017
• 2. Correctly prescribe warfarin in iCentra
• 3. Utilization of the Monthly Patient Watch List
• 4. Anticoagulation webpage

Objectives

Our Proposal

iCentra “Go- Live “

• Training to include anticoagulation training taught by the iCentra ambulatory workstream, not clinical

program

• Operation leadership to appoint both an MD and other clinical team member to serve as anticoagulation lead

for the clinic.

Maintenance (On iCentra and using the protocol)

• Laurel will hold quarterly meetings with:
• The appointed PPC anticoagulation lead
• Staff anticoagulation lead
• John Bracken’s team
• Clinical Quality Region Lead
• iCentra ambulatory workflow leads
• John Bracken’s team will train new employees

Models

Each Provider manages their own patients

• Point of Care in the clinic (preferred method)
• Utilization of lab services

Region Anticoagulation Clinic managed by APC or pharmacy services

Medical Group Leadership

Responsible for operations to provide safe and effective management

• f patients who require anticoagulation.

The Ask: Support Anticoagulation best practice philosophy and operationalization Assure physicians and staff participate in iCentra “Go Live” training Allow for clinical staff to enroll patients into the protocol prior to “Go Live” Define a workflow for each clinic (POC vs lab) Identify a physician leader and clinical staff leader in each clinic and have them attend clinical program quarterly meetings

Prescribing Warfarin in iCentra

Pre-populated Warfarin Orders can be added to your favorites.

Prescribing Warfarin in iCentra

Weekly doses will be managed in the Anticoagulation workflow, not the medication list.

Review your list to determine

• Is this patient still taking warfarin? If not, remove the

patient from the protocol.

• If they are taking warfarin, does the indication warrant

indefinite therapy or perhaps are they a candidate for cessation (e.g. surgically provoked DVT/PE).

• If they require continued anticoagulation therapy and are

having a difficult time achieving a safe time in therapeutic range (TTR), can modifiable barriers to optimal anticoagulation be identified?

• Seeing patients with poor INR control more frequently is

associated with improving TTR.

• Among patients on warfarin with suboptimal

anticoagulation control, might transition to a DOAC be a consideration?

• A dedicated visit to address anticoagulation therapy can

improve quality of anticoagulation management.

Updated anticoagulation Web page

https://m.intermountain.net/clinical/pc/topics/Pages/Anticoagulation--- Outpatient.aspx