Anticoagulation Clinic Guidelines (Draft) Dean Medical Center
Download 0.58 Mb.
|
- Navigate this page:
- Dean Anticoagulation Clinics COLLABORATIVE CARE AGREEMENT
- Dean Anticoagulation Clinics INDICATIONS AND THERAPEUTIC RANGES
- INDICATION TARGET INR (RANGE) DURATION COMMENT
- Left Ventricular Dysfunction
- Acute Myocardial Infarction (MI)
- Thromboembolism (DVT,PE)
- Valve Replacement-Bioprosthetic
- Valve Replacement – Mechanical
- PERMISSION FOR VERBAL COMMUNICATIONS
- If, at any time, I do not want this information to be left on my answering machine or I want to change the names of the people listed above, I must notify the Anticoagulation (AC) clinic
- INSTRUCTIONS: Please sign this form and send to the following location
| Anticoagulation Clinic Guidelines (Draft)
Dean Medical Center The Anticoagulation Clinic(AC Clinic) is a service staffed by pharmacists and nurses with specific knowledge in anticoagulation therapy. Anticoagulation care is managed under the supervision of the AC Clinic Medical Director and the patient’s physician. I. Goals and Objectives A. To provide services to physicians initiating anticoagulation therapy and assist physicians in the management of oral and parenteral anticoagulants. B. To provide consistent management and follow-up care for patients receiving anticoagulation therapy by evaluating patient-specific data and pertinent laboratory tests dependent upon the anticoagulant regimen. C. To provide consistent education to the patient and/or family members about warfarin and other anticoagulant therapy. To make them aware of potential problems during therapy and the signs and symptoms of bleeding, embolic events and other adverse effects. D. To consistently identify patients who are non-adherent with the anticoagulation care plan and provide education to improve adherence and reduce the potential for adverse events and maximize the benefits of treatment. . E. To maintain an anticoagulation flowsheet for each patient and provide complete documentation of the care provided in the patient’s electronic medical record. F. To consult with other providers involved with the patient’s care when needed. II. Scope of Care A. Patient Referral 1. Patients may be referred to the AC Clinic if they have demonstrated the capability to self-administer medication, or have a responsible caregiver who can supervise the medication administration, or other acceptable process in place to ensure adherence to the treatment plan. A reliable method of communication must exist for the patient to be enrolled in the AC Clinic. The AC Clinic is unable to manage the patients with the following issues: b. underlying psychiatric problems hindering adherence to program expectations c. inability to adhere to care plan d. patients with no reliable means of communication Patients may be referred to the AC Clinic at any point during anticoagulation therapy provided that a collaborative care agreement exists between the AC Clinic and the supervising physician (See below: Collaborative Care Agreement). The patient must be assessed by the supervising physician periodically to determine need for further anticoagulation therapy. Dean Anticoagulation Clinics COLLABORATIVE CARE AGREEMENT I, __________________________________ MD / DO, acknowledge that I have read and approve the Guidelines of the Dean Anticoagulation Clinics (AC Clinic). My signature on this document authorizes the AC Clinic clinician to monitor my patients’ anticoagulation therapy. This collaborative agreement may be terminated at any time for an individual patient either by me or the AC Clinic clinician for any reason including: anticoagulation therapy is discontinued, patient desires to be followed by the primary physician alone, or the patient misses 3 consecutive appointments, blood draws or other laboratory test used to maintain control of the anticoagulation therapy without contacting the AC Clinic staff. Check all of the following that apply: ___ It is not necessary for the AC Clinic clinician to call me for routine changes in therapy.
patient’s pharmacy on my behalf. Physician’s Signature___________________________________ Date_______________ Please print name____________________________________________________________
4. Referrals to the AC Clinic can be made by the primary physician verbally, by electronic referral, or by written orders. The referral should indicate the reason for use, desired intensity of treatment, and planned length of treatment. If the physician has already prescribed a dosage of the anticoagulant, the strength of medication and dosage per day needs to be indicated. 5. The AC Clinic will establish a computerized patient file for each new referral. After reviewing the patient’s medical record, the AC Clinic clinician will complete a initiation form in Epic. The patient’s medical record will be evaluated to obtain the information listed below. If not specified by the primary physician, the desired INR range will be based on the current American College of Chest Physicians Consensus Conference guidelines for the specific indication along with individual patient characteristics. The AC Clinic clinician will contact the physician, when needed, to determine the target range and duration of treatment for the intended therapy. The AC clinician will provide the physician the literature recommendations for usual target range and duration of therapy for the specified indication, if needed. The computerized medical record should have the following information available to the AC Clinic clinician for review: a. patient name, address and telephone number (home/work) b. emergency notification contact (telephone number home/work) c. date of birth, weight, height, gender d. current medications, including prescription and nonprescription e. medical history: known diseases and surgeries, drug allergies and reactions, conditions relating current medication regimen, surgical history, and hospitalizations. f. indication for anticoagulation therapy g. target INR range and planned duration of therapy h. if already receiving anticoagulation therapy include: start date, current dose i. history of bleeding including major and minor (dates and outcomes) j. physician name, direct office telephone number, pager number, and fax number
Hx, history; TIA transient ischemic attack; TE, thromboembolism; HTN, hypertension; CHF, congestive heart failure; , lowered; LV left ventricular; fxn, function; dysfxn, dysfunction; dx, disease; CAD, coronary artery disease; AF, atrial fibrillation; NSR, normal sinus rhythm; MI myocardial infarction; tx, treatment; DVT, deep venous thrombosis; PE pulmonary embolism; s/p, status post; LA, left atrium; EF, ejection fraction 6. All referrals to the AC Clinic must have a supervising Dean Medical Center physician who is responsible for periodically assessing the patient’s continuing need for anticoagulation therapy and management of medical/surgical problems. If difficulties arise, such as, lack of cooperation, continued non-adherence with INR blood draws, the primary physician will be made aware of the issues by the AC Clinic clinician. A note will be placed in the patient’s medical record describing the problem, discussion with the primary physician, and agreed upon course of action. If the issue continues to be problematic despite repeated efforts to rectify the problem, the patient may be referred back to the primary physician for reevaluation.
In addition to adherence issues, the AC Clinic clinician will notify or, if needed, refer the patient back to the primary physician or proceed to the hospital ER in the following circumstances: a. consultation with a physician is requested by the patient b. the AC Clinic clinician notes findings suggestive of another worsening medical problem
c. there is evidence suggestive of gross hematuria, gastrointestinal, or other bleeding d. there is evidence suggestive of worsening thromboembolic disease e. assessment of continuing need for anticoagulation is warranted
desired length of treatment has been reached, the the AC Clinic clinician will refer the patient back to the primary physician to evaluate the need for continued anticoagulation. Discharge from the AC Clinic will occur by physician order when: a. anticoagulation therapy is discontinued b. the patient desires primary physician to manage anticoagulation c. the primary physician decides to manage anticoagulation d. the patient violates adherence policy (see B.3) 10. The AC Clinic clinician must provide consultation only with the patient via an inclinic appointment, the telephone, US mail or MyChart. The AC Clinic clinician can leave a message on the patient’s voice mail or answering machine or speak with a family member, activated power of attorney for healthcare, or other designated person provided that the patient completes and signs the AC Clinic verbal permission form (see below). The completed and signed formed must be scanned into Epic by Medical Records. PERMISSION FOR VERBAL COMMUNICATIONS (print name of patient or place patient label here) (birthdate) (street address) (city, state, zip code) (phone number) I permit Dean Health Systems, Inc. Anticoagulation (AC) Clinic personnel (“Health Care Providers”) to leave information regarding ongoing anticoagulation therapy on my voice mail or answering machine. In addition this authorization allows the AC personnel to discuss health information, in person or by telephone with the following family members or friends involved in my medical care: (List family members/friends and state the person’s relationship to the patient).
Patient’s Signature: Date: If this Release is signed by a representative on behalf of the patient, complete the following: Representative’s Name: Relationship to Patient: If, at any time, I do not want this information to be left on my answering machine or I want to change the names of the people listed above, I must notify the Anticoagulation (AC) clinic: by telephone at 608-252-8060, or by mail at the address listed below, or in person at the Anticoagulation Clinic at Dean Clinic. INSTRUCTIONS: Please sign this form and send to the following location:
Rev 1/28/09 Clinic Procedures - AC Clinics: For Dean Fish Hatchery Road AC Clinics see visio below; For Riverview and Stoughton AC Clinic, see attached guidelines. 
Directory: sites -> default -> files files -> Answer True False 2 points Question 2 files -> Northern England’s set-jetting locations files -> Nstructions for Acquiring Excess Equipment online, through the 1033 Program files -> Occupational health and safety files -> The Black Panther Party’s Ten Point Program files -> International programs roel profile files -> Fermi Questions a guide for Teachers, Students, and Event Supervisors Lloyd Abrams, Ph. D. DuPont Company, cr&D/ccas experimental Station Wilmington, de 19880 files -> Personal Information Name: Maha Al-Ammari Nationality: Saudi Relationship Status Download 0.58 Mb. Share with your friends:
|