Missed appointments (no shows) – AC Clinic dismissal process

**Per agreement with the Primary Care Leadership at Dean Clinic with the Dean Anticoagulation Clinics in 2011: non adherent patients, who have fully progressed through the process outlined above, will be sent back to their PCP to reassess the appropriateness of continued anticoagulation.  If the patient is thought to be best served by anticoagulation, the AC Clinic would consider resuming care if the patient agreed to be compliant (that is, after the PCP has discussed the potential "second chance" with the patient). If during this “second chance” with the AC Clinic, the patient remains non adherent with their recommendations, the AC Clinic would not continue to monitor further anticoagulation therapy . The AC Clinic will inform the PCP of this action. The PCP will need to make the clinical judgment about further treatment and, if continued, the PCP would manage the anticoagulation therapy.

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  FLOWSHEET- IS THE ANTICOAGULATION CLINIC SMARTFORM
  
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  EXCEL FILE - FILE AC CLINIC USES TO TRACK THE LIST OF PATIENTS AND NUMBER OF REMINDER CALLS MADE.
  

4. Initiation of warfarin therapy:

a. Obtain Baseline INR.

b. Begin warfarin at 5 - 10 mg daily (may need lower dose such as 2-2.5 mg/day in

patients with coexisting medical problems, concurrent interacting medications or with

known or suspected sensitivity to warfarin. Have patient take warfarin in the

evening.

c. Return to clinic or laboratory for INR testing as specified in B.5

dosage adjustments until the patient is anticoagulated and the INR results are stable

(defined as two similar, consecutive therapeutic INRs). The AC Clinic will use the

consensus guidelines for the frequency of INR monitoring as follows:

b. Then every 2 weeks until stable.

c. Then every 4 weeks unless special circumstances exist.

d. If previously stable INR, becomes unstable then proceed back to a. or b. above.

e. If INR is slightly out of range, repeat within 1 month. If still out of range then adjust

warfarin regimen.

6. For inclinic appointments, vital signs (blood pressure, pulse, etc.) should be

measured if not done within last 48 hours, then documented in the medical record. Patients

arriving early will be seen as soon as possible. Walkins will be seen as soon as possible as

space permits in the AC Clinic schedule.

patient will be instructed to go to the nearest Emergency Room or call 911.

Bridging, the AC Clinic clinician will consult with the appropriate provider to arrange a care plan