facilitating optimal discharge plans for high risk patients …促石进高风险患者的最佳治疗方案….pptVIP

Massachusetts General Hospital Anticoagulation Management Service Lynn B. Oertel, MS, ANP, CACP Clinical Nurse Specialist Presented November 4, 2008 2008 NPSG (selected) 8 - Accurately and completely reconcile medications across the continuum of care 9 - Reduce the risk of patient harm resulting from falls 13 - Encourage patients’ active involvement in their own care as a patient safety strategy 15 - The organization identifies safety risks inherent in its patient population NQF Safety Standards Safe Practice 17: Evaluate each patient upon admission, and regularly thereafter, for the risk of developing DVT/VTE. Utilize clinically appropriate methods to prevent DVT/VTE. Safe Practice 18: Utilize dedicated anti-thrombotic (anticoagulation) services that facilitate coordinated care management.  Goal is to reduce incidence of surgical complications nationwide by 25% by 2010 SCIP VTE1 – Surgery patients with recommended VTE prophylaxis ordered SCIP VTE2 – Surgery patients who received VTE prophylaxis within 24 hours after surgery OSG Call to Action – Sept 15, 2008 The Joint Commission Sentinel Alert – Sept 24, 2008 Clinic overview Patients = 4100+ Mean age = 69 yrs, SD 13.65, range 20 - 100 Common indications for treatment: AF ? 57% VTE ? 15% Heart Valves ? 9% INR intensity ranges 2 – 3 ? 87% 2.5 – 3.5 ? 9% By request, selected others Admissions: ~75/month + Reactivated patients ~ 60% new referrals from inpatient (POE Consult referral) Discharges: ~ 90/month Time in Therapeutic Range TTR calculated using Rosendaal method Strict range limits, eg. 2 – 3 and 2.5 – 3.5 Using ALL INR data (induction, interruptions, etc) Percent INR tests out-of-range In Range (2 – 3) = 60% Above 3 = 15% Below 2 = 25% Communication and Education for Patients and Physicians Key elements for improvedpatient management Patient focused, primary nurse model Physician Order Entry for AMS Consult Referral (nearly all data fields mandatory for submissi