Sharing of Best Practices: Leveraging DAWN AC and a unique staffing - - PowerPoint PPT Presentation

Sharing of Best Practices: Leveraging DAWN AC and a unique staffing model for a successful practice

Kaiser Permanente Washington Region Paul Kuo, PharmD Manager, Anticoagulation and Anemia Management Service

Our Mission Kaiser Permanente exists to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Our Vision We are trusted partners in total health, collaborating with people to help them thrive and creating communities that are among the healthiest in the nation.

Kaiser Permanente Washington Region

• Formerly Group Health Cooperative, founded in 1947
• Acquired by Kaiser Permanente in 2017
• Managed Care Organization offering HMO, PPO, and Medicare

Advantage Plans

• 680,000 Members
• 25 Full-Service Outpatient Medical Centers
• 15 Walk-in Clinics located inside partner retail pharmacy chain
• 5 Urgent Care Locations
• 3 Ambulatory Surgery Centers
• Contracted Hospital Services
• 24/7 Consulting Nurse Service

| CONFIDENTIAL 3

Anticoagulation and Anemia Management Service (AMS) Overview

| CONFIDENTIAL 4

PCR

3.0 FTE

MA

3.0 FTE

LPN

4.7 FTE

Midlevels

8.0 FTE (RPh & ARNP)

Call triage, patient letters, faxes, non-attendance outbound calls Open patients in DAWN, Email/Epic message triage, PST Program, processing referrals Low acuity, stable, in-range patients High acuity patients: New starts, peri-procedural management, DOAC initiation and monitoring, anemia management, refills Centralized telephonic management of Warfarin, LMWH, DOACs, Epoetin, and Iron

RN

9.0 FTE

Moderate acuity patients, INRs between 1.0 and 6.0, DOAC monitoring and education

7000

Warfarin patients

350

DOAC patients

100

Anemia patients

2000

Procedure Plans annually

Anticoagulation and Anemia Management Service (AMS)

Staff:

• 3 Patient Care Representatives (3.0 FTE)
• 3 Medical Assistants (3.0 FTE)
• 5 Licensed Practical Nurses (4.7 FTE)
• 10 Registered Nurses (9.0 FTE)
• 10 Midlevels: 1 ARNP (0.5 FTE) /9 Pharmacists (7.5 FTE)
• 1 Administrative Assistant (1.0 FTE)
• 32 Total Staff + 1 Manager

Clinic Hours: (After hours support by Consulting Nurse Services)

• Mon-Fri: 8:00am to 5:00pm
• Sat: 8:00am to 4:00pm (1 LPN, 1 RN, 1 ML)
• Sun: 3:00pm to 5:00pm (1 ML/work from home)

| CONFIDENTIAL 5

Anticoagulation and Anemia Management Service (AMS)

Clinic Organization:

• 25 Medical Centers divided into 3 Clinics
• 3 Clinics (Green/Blue/Yellow) of over 2000 patients each
• Each Clinic consists of:
• 2 ML
• 2 RN
• 1 LPN
• Additional flex staff assigned to cover specific duties as clinic

needs fluctuate (i.e. incoming calls, referrals, procedures, etc)

• Each clinic provides care for all needs (Warfarin, LMWH, DOAC,

Anemia)

| CONFIDENTIAL 6

DAWN AC Risk Classes

• Low
• Low with Drug Interactions
• Medium
• Medium with Drug Interactions
• High
• Bridge
• Enoxaparin Only
• Enoxaparin Transition
• Unclassified

| CONFIDENTIAL 7

LPN RN Midlevels Other

DAWN AC Letters

Direct Print

• New Patient Packets
• Travel Letter
• Overdue Letter
• Unable to Reach Letter
• In-Range Letter
• Transition of Care
• Insurance Termination

Custom Messages

• Lab Orders and AMS treatment

notes sent to Lab Information System interface which interfaces into Epic

• Faxed Orders and

Communications sent through RightFax interface

| CONFIDENTIAL 8

DAWN AC Setup

Reminders

• Used by MA’s to assign a new referral

patient to the clinic for work up

• Used by ML’s as clinic task list for Non-

INR work and follow-up reminder system

Other Features in Use

• Non-Attendance
• Procedures
• Groups: Used to track patients in our

Self-Testing Program

• Drugs: Document Drug Interactions
• Events: Track Adverse

(Bleeding/Thrombosis) Events

• Review: MA’s use to review

continuation of care after initial specified duration of therapy on referral – contacts physician for referral extensions

• Status: Patients suspended from

service due to non-compliance

| CONFIDENTIAL 9

Outcomes

| CONFIDENTIAL 10

What’s Next?

• DAWN AC Patient Self-Testing Module
• Expanding use of DAWN Messaging for internal communications
• Extending the maximum testing interval to 12 weeks
• Monitoring adverse events from claims data
• DOACs

| CONFIDENTIAL 11

Discussion/Questions