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Systematic Anticoagulation Management in the Rural Health Setting Lisa Vaughn RN, CACP Clinical Manager Anticoagulation Services Wenatchee Valley Medical.

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Presentation on theme: "Systematic Anticoagulation Management in the Rural Health Setting Lisa Vaughn RN, CACP Clinical Manager Anticoagulation Services Wenatchee Valley Medical."— Presentation transcript:

1 Systematic Anticoagulation Management in the Rural Health Setting Lisa Vaughn RN, CACP Clinical Manager Anticoagulation Services Wenatchee Valley Medical Center

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3 Serving more than 160,000 unique 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, PAs, & ARNPs 1500 Employees in eleven communities and four counties Wenatchee Valley Medical Center

4 Wenatchee East Wenatchee CashmereMoses LakeRoyal CityBrewsterOmakTonasketOrovilleWaterville

5 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 nations best rural health care delivery systems

6 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

7 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

8 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

9 Standardized System Wide: Policies and Procedures Patient education resources Peri-op/procedure program Documentation tools (Coded Comments)

10 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

11 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

12 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

13 Throughout all locations Advanced Practice Provider Practice Plans Anticoag Clinic physician oversight Administrative support Staff and provider coverage for time off Pharmacy support

14 Shared Resources

15 Shared Medical Record DAWN AC – continuum of care between ACC locations EMR with interfaces with DAWN AC

16 Interactive Medical Record Cadence EpiCare DAWN AC

17 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

18 DAWN – EMR ADT Interface Demographic information Appointment scheduling Tracking and documenting non compliance in DAWN

19 Cadence Appointment Dawn Dose Schedule

20 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 EMREpicare Link Peri-procedure/surgical anticoag management plan – Two hospitals

21 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

22 Load Leveling DAWN List Views Annual Order Updates Tracking No Show And Non-compliance Tracking Hospital Admits ACC Required Related Lab Tests New Patient Pre-work Risk Class New Starts Acute to Chronic

23 List Views Filter by provider

24 Cross Coverage Telemedicine Visit Weekend Coverage Peri-operative/procedure management Unexpected INR results

25 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

26 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

27 List View - Worklist

28 List View-Risk Class

29 List View-All Patients

30 List View – New Patients

31 List View – Annual Requirements


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