Systematic Anticoagulation Management in the Rural Health Setting Lisa Vaughn RN, CACP Clinical Manager Anticoagulation Services Wenatchee Valley Medical Center
Mar 26, 2015
Systematic Anticoagulation Management in the Rural Health Setting
Lisa Vaughn RN, CACPClinical Manager Anticoagulation ServicesWenatchee Valley Medical Center
Serving more than 160,000unique patients annually….
….over 750,000 patient visits per year in an area that covers 12,000 square miles
300 Physicians, Physician Assistants, and Nurse Practitioners….85 Primary Care Physicians, PA’s, & ARNP’s
1500 Employees in eleven communities and four counties
Wenatchee Valley Medical Center
Wenatchee Valley Medical Center
Waterville
Oroville
Tonasket
Omak Brewster
Royal City
Moses Lake
Cashmere
East Wenatchee
Wenatchee
Our Mission
To provide our patients with the highest quality health care and service in a friendly and caring atmosphere
Committed to assisting in the development of one of the nation’s best rural health care delivery systems
Common Scope of Service
Face-to-face visits with APC Patient Self Testing Televideo appointments Home visits POC INR Testing EMR Patient access for lab results, RX renewal,
scheduling, health care questions Patient Education – NOA My Chart access to medical records,
scheduling and health advice
DAWN AC - Organization 7 ACC locations with 8 full time
and 4 part time advance practice providers
2100 patients 5 separate DAWN Organizations Providers with DAWN clinics at
multiple organizations DAWN groups – Home Visits, Self
Testing and APS
Collaboration to Provide Safe Care Patient Tracking Quality Measures
• TTR• Elevated INRs• Time to Therapeutic• Clinical outcomes (Bleeding, TE, Fatalities)
Staff Proficiency and Competency ACC specific practice plan for APCs Standardized Lab Monitoring – POC INRs,
POC-Lab Correlation Studies
Standardized System Wide: Policies and Procedures
Patient education resources
Peri-op/procedure program
Documentation tools (Coded Comments)
Systematic Therapy Management
Evidence Based Protocols:• Warfarin Induction• Risk Assessment • Managing Non Therapeutic INRs• Follow-up Intervals• Peri-procedure/operative Management• Elevated INRs• Anticoagulation Related Labs• Management of Patients with APS
Systematic Scheduling
Transition of care inpatient-outpatient New Patient Enrollment Routine Follow Management of No Shows Management and Documentation of
Non Compliance Peri-procedure/operative visits
Teamwork
Job descriptions/APC Practice Plan Staff and provider training and CME Performance Improvement Projects CACP Certification Bi weekly meetings Standardized workflows Weekend and holiday service
Throughout all locations Advanced Practice Provider Practice Plans
Anticoag Clinic physician oversight
Administrative support
Staff and provider coverage for time off
Pharmacy support
Shared Medical Record
DAWN AC – continuum of care between ACC locations
EMR with interfaces with DAWN AC
DAWN – Lab Interface
Lab-all WVMC lab locations export INR to DAWN
Diminishes manual data entry errors No delay in time from reporting to
appearance in DAWN List View Worklist
Undosed INRs visible at all ACC locations
DAWN – EMR ADT Interface
Demographic information
Appointment scheduling
Tracking and documenting non compliance in DAWN
DAWN – Communication with Multiple Health Care Providers
Exporting DAWN Quick Note to EMR and link in EMR to DAWN
Immediate access to DAWN records:• Other WVMC healthcare providers• Outside healthcare providers: DAWN→EMR→Epicare
Link
Peri-procedure/surgical anticoag management plan – Two hospitals
Shared in DAWN Treatment Plan Annual physician order updates - Reviews Patient tracking – List Views Quality Measures – Benchmarking and
Reports Patient Education – Letters Groups- Home visits, APS, PST
Documentation – Coded Comments
Load Leveling
DAWN List Views
Annual Order Updates
Tracking No ShowAnd
Non-compliance
Tracking Hospital Admits
ACC Required Related Lab
Tests
New Patient Pre-work
Risk ClassNew Starts
Acute to Chronic
Cross Coverage Telemedicine Visit
Weekend Coverage
Peri-operative/procedure management
Unexpected INR results
Looking Forward
Increase in patient population+
Multiple locations for care+
Addition of new anticoagulants
Continued need for expertise and standardization and systematic process for administrative and clinical
management
Reference
Delivery of Optimized Anticoagulant Therapy: Consensus Statement from the Anticoagulation Forum
David Garcia, Daniel M Witt, Elaine Hylek, Ann K Wittkowsky, Edith A Nutescu, Alan Jacobson, Stephan Moll, Geno J Merli, Mark Crowther, Laura Earl, Richard C
Becker, Lynn Oertel, Amir Jaffer, and Jack Ansell
The Annals of Pharmacotherapy 2008 July/August, Volume 42