Point of Care Blog

Part 5 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines.

Before we get to part 5 and the final post in this series on Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines, we previously covered:

Part 1: Adverse Drug Events Related to Anticoagulation/VKA  

Part 2: Use of Outcome Measurements: Warfarin, NOACs and How They Apply to MU and National Quality Measures 

Part 3: Clinical Decision Support Tools in the Dosing of Both Warfarin & NOACs 

Part 4: Overview of EHR Key Features Necessary for Delivering Optimized AC Therapy 

This information has led us to our final part in this series of Northwell Health System’s integration with the Point of Care Decision Support Anticoagulation (AC) management system.  We are in the process of incorporating this AC clinical decision support system within our very large, 23-clinic Anticoagulation and Clinical Thrombosis Services at Northwell Health System.  I am very proud to be Medical Director one of the largest, virtual anticoagulation clinics in the United States.

Part 4 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines.

To pick up where we left off on part 3, let’s review a few priority key features of an EHR that can advance chronic oral anticoagulant care as outlined by the EHR Task Force Consensus Group.

Key features depicted in Figure 1 include:

• patient level demographic data
• treatment data including the indications for anticoagulant therapy
• for those on warfarin, the target INR intensity and start date
• recommended duration
• tablet strength of warfarin
• risk factors for bleeding and thrombosis
• main route and frequency of administration of anticoagulants or other drugs
• importance of communications both from provider to patient, but also from patient back to provider

Part 2 in a 4 part series.  Click to read the Introduction and Part 1.

Every patient has a unique set of needs and expectations. According to the Institute of Medicine (IOM), there are unprecedented challenges to how we identify and deliver the most appropriate care for individual needs and conditions (IOM, 2011).  In part one of this series, we looked at clinical tools that can help us to understand the most vulnerable patients and the care they require. In part two, we will peel back the problem of, “Care that is important is often not delivered. Care that is delivered is often not important (IOM, 2011).”

In Part 1, we discussed the focused information clinicians need to quickly assess an anticoagulation patient’s health and a review of patient treatment plan trends.  Here in part 2, we will discuss the many ways to identify patients who are at risk for drug interactions or re-admissions, and evidence-based guidelines that support dosing decisions.

 Identify Patients at Risk

There are many ways to identify patients that require a bit of extra scrutiny.  PCDS believes it is important that a clinician is immediately made aware of any patients with higher than normal levels of risk given their care plan.  We further believe it is important that risk identifiers be objective and measurable.  That is why AC has three validated survey instruments built into the application for easy access, execution as well as to clearly demonstrate the results of completed surveys when they indicate patients may be at risk.

 When I accepted the opportunity to join Point of Care Decision Support (PCDS) last year, people were curious. Considering everything going on in healthcare today, why PCDS?

I could have reflected on all the positive reasons why it made so much sense:

• The entrepreneurial spirit of the company.
• The solid technology base of the solution.
• The tremendous growth happening in the healthcare marketplace.