ࡱ> NRIJKLM ?bjbj44 cVV'`4hz~T $ծXΫ9z"' z"z"Ϋ'''z"'z"''z"42Jw#Vj`r߱#߱22&߱X< L+!6'a!,! ΫΫ%  z"z"z"z"߱  :   Anticoagulation Clinic Protocol Book  SHAPE \* MERGEFORMAT  Anticoagulation Clinic Location Hours 1538 Monday, Tue, Thurs & Friday 8am 4pm 1450 Monday Wednesday, Thursday 8am-4:30pm 199 TBD 1632 Monday, Tuesday & through Friday 8:30 am-4:30pm 1632 Wednesday & Thursday 8 am -5:00 pm  SHAPE \* MERGEFORMAT  Anticoagulation Clinic Protocol In order to provide for consistent management of Coumadin patients, the following process should be used to order and document a patient coagulation check at every visit every time. Initial Coumadin Visit At the time of the first Coumadin visit, the following patient education information will be discussed with the patient: Using Coumadin Safely at Home Vitamin K Content of Selected Foods Coumadin Interaction with Medications Anticoagulation Management: Patient Agreement Plan Every Coumadin Visit- Site Specific During Open the anticoag visit and follow the prompts (See NCH Anticoagulation RN Quick Start Guide on the Learning Home Dashboard in EPIC) Follow Coagucheck XS Procedure if POC INR is done during visit. coagulation visit, the following steps should be taken Within the patients chart, identify diagnoses (indications) for Coumadin management Display Coumadin flow sheet outlining previous INR results Start Coagulation Clinic chart note and complete the following Reason for Visit: Coagulation Check HPI: Enter any questions/concerns the patient may have as well as any upcoming procedures, results from tests, upcoming appointments with specialists Order Coumadin Panel within Labs/Procedures Link test to appropriate diagnosis Obtain INR Level using the Coagucheck XS device Record results under Results tab including: Date and time INR was collected Indication Coumadin Start Date Therapeutic Range PT/INR (result obtained) Current Coumadin Dose Changes to Meds or Diet (ask patient and comment as appropriate) Signs or Symptoms of bleeding (examine/ask patient and comment as appropriate) New Dose (as appropriate, see Dose Adjustment and Coumadin Management Algorithms) Next INR Test Date (as appropriate) Patient Education (as appropriate) Patient Contract Signed Date INR, use this space to document recheck of INR if pervious results was <1.5 or >5.1 Under Assessment in the chart note put appropriate diagnosis/indication for Coumadin Finish the note by documenting when the patient is follow-up under Plan Save and Sign the note Send the note to the patients PCP/Cardiologist for cosignature attestation as required by site- specific protocol A second Coumadin Panel is ordered before patient leaves so that it will create an overdue reminder if the patient does not return for their next coagulation visit This patient encounter can be found within the Coumadin Management Sub-section of the patents chart Prior to the patient leaving, provide them with their AVS complete the Coumadin Dosage Calendar and give to patient Answer any additional questions the patient may have Patients with secondary issues or concerns will be directed to follow-up with their PCP/Cardiologist Log the patients results into the Coagucheck XS Patient Test Log Keep logs in safe place and retain for two years Use a new log each day Frequency of Visits (Face to face or PT/INR testing) Patients will schedule appointment for all Coumadin managementAnticoag visits Walk-ins will be seen; however appointment will be made for follow-up visit. Patients will return to the office for anticoagulation as indicated by the Dose Adjustment, Coumadin Management Algorithm and healthcare clinician discretion Stable patients MUST BE seen in office at least once per monthhave an INR done each month (except in cardiology) Patients who have INR obtained through the lab MUST be seen in office by the PCP/Cardiologist or ordering physician quarterly yearly. Patients new to Coumadin or are bridging before/after a procedure may need to be seen more than once per week. Patients will be billed a maximum of ONE office visit per week (99211) if face to face and needing close monitoring. Patient who are called with lab results from home monitoring are billed (MDRVWIN) or MD review of results every 5 weeks (or every 5th test). Remaining visits will only be billed as Coagucheck (85610) lab charge (charge is dropped when test is resulted) Billing and Coding 99211 Office visit code for Coagucheck Note to include Vital signs Thorough exam of the patient to check forAsk patient if they have any bruising Review with patient of all current medications Review with patient regarding diet Past INR result Todays INR result Discussion with the patient regarding any change in dosage Management of Outside INRs not done in the PCP/Cardiologists office Home Health and outside lab results will go to the appropriate Coag pool. patients PCP/Cardiologist and MA with oversight and management by the healthcare clinician Patients who have INRs obtained through the lab MUST be seen in office at the discretion of the managing physician. There will be home monitoring of INR values at the discretion of the managing physician.. Patients who travel and are not able to have their INR managed in office will have arrangements made to obtain INR Standing order will be given to patient for INR lab draw on a PRN basis Results will be faxed to ordering provider and then routed as appropriate (PCP/Cardiologist and/or RNMA with oversight and management by the healthcare clinician Certain circumstances may arise where a patient will request to have their INR obtained outside of the Coumadin Anticoag Clinic. This will be addressed on a case-by-case basis with the patient's PCP/Cardiologist and Coumadin Anticoag clinic RN staff.. If approved, results need to be faxed the same day to NCH site. Patients will need to be seen in the Coumadin Clinic at the discretion of the managing provider. Patients must be seen yearly by managing physician in the office for anticoagulation management. Information relating to management of Outside INRs will be documented within the Anticoagulation Encounter chart note. Include Anticoagulation Encounter l filling out appropriate fields as discussed above Cleaning the Coagucheck Machine Clean the outside of the device with 70% Isopropyl Alcohol pads after EACH patient use Clean the device internal strip with 70% Isopropyl Alcohol at the end of EACH day Protocols Bridging Coumadin with Lovenox This will be done per the patients Primary Care Provider, Cardiologist or GI Specialist Physician contact regarding Coumadin questions Managing Physician or Covering Physician at the specific site Attachments Patient Education Material Using Coumadin Safely at Home Vitamin K Content of Selected Foods Coumadin Interaction with Medications Anticoagulation Management: Patient Agreement Plan Coumadin Adjustment Guidelines Dose Adjustment and Coumadin Management Algorithms Patient Hand-out Coumadin Dosage Calendar Coagucheck Tracking Coagucheck XS Patient Test Log Coumadin Training EMR Documentation and Training Coagucheck XS Device Training  SHAPE \* MERGEFORMAT  Using Coumadin Safety at Home What is Coumadin? Coumadin is an anticoagulant (anti= against, coagulant= clotting) Coumadin is a strong medication that slows your bodys ability to form a blood clot Some people call Coumadin a blood thinner Coumadin is also known as Warfarin- the generic name for Couamdin Generic Coumadin (Warfarin) is made by several different companies- take only as prescribed How to I take my Coumadin? Take your Coumadin only as directed by your provider Try to take your Coumadin at the same time every day- preferably in the evening Do not take more than prescribed as it could cause bleeding Why do I need my blood tested? Blood tests call INRs tell your provider just how much the medicine is working Blood tests will be needed for as long as you are on Coumadin Other medications and food will change the results of your INR frequency The doctor will try to get your INR in a target range What is an INR? The INR is the name given to the results of your blood test The INR will be a number such as: 1.7 or 2.0 or 2.6 or 3.8 or 5.8 The higher the number, the longer it will take your blood to clot Your provider will tell you where your INR needs to be An INR target range will be made for you An INR too high increases your changes of bleeding An INR too low does not protect you from bad blood clots that might form Is my diet important? Consistency in your diet and steady portion sizes is most important Many foods can change your INR Vitamin K is an important vitamin to learn about Vitamin K slows or can stop Coumadin from doing its job Vitamin K is found in leafy green vegetables and other foods and teas Ask your provider if you are unsure of a certain food type What do I do if I miss a dose? Coumadin is a strong medicine that lasts for days, check with your provider if you miss a dose Dont panic, missing a dose is not life-threatening but getting back on schedule is important Never take an extra Coumadin tablet to catch up unless instructed by your provider What are signs of trouble? Bleeding gums, blood in your urine, black or tarry stools are sings of too much Coumadin Unusual or excessive bruising is a sign of too much Coumadin A high INR, well outside your target range placed you at risk of bleeding What else do I need to know? Report to all your blood test appointment and office visits Check before starting or stopping ANY vitamin or nutritional drinks Report any fevers, bad colds or flu as this will affect your INR Report any bumps, bruises or cuts as Coumadin will make it bleed longer Many over-the-counter medications can affect your INR- including stomach medicines, calcium supplements and cold and flu medications to name a few Keep your providers office phone number with you and by the phone Dos Talk to your provider about any concerns or questions regarding your Coumadin Remain consistent in your diet and portion sizes of fruits and vegetables Talk to your provider before starting or stopping ANY medication Wear gardening gloves and closed toe footwear when working outside Place knives and forks point down in the dishwasher Consider a life-line pendant if you live alone Consider a bracelet that lets emergency personnel know you are on Coumadin Clear stairways of books, papers, shoes and other clutter Use nightlights to illuminate walkways to bathrooms Use handrails and contact tape on all tubes and showers Use soft bristle tooth brushes Use pillboxes, it is very easy to forget if you took your tablet or not Use electric razors for shaving If you test at home weekly, call in your INR result as instructed Donts Dont run out of medication Dont miss lab appointments or provider visits Dont reach in or push the garbage down Dont binge on any fruit or vegetable Dont dink excessive alcohol with Coumadin Dont reach into soapy water in the sink where silverware and dishes soak Dont wear footwear that is we on hardwood or linoleum floors Dont guess whether you took your Coumadin, make sure you dont double up Dont forget changes in dose or diet takes days to change our INR  SHAPE \* MERGEFORMAT  Vitamin K Content of Selected Foods This is not a list of foods to avoid. This list provides information on the vitamin K content of certain foods. Vitamin K Content FOODSLOWMODERATEHIGHVegetablesGreen BeansAsparagusBroccoliCarrotsAvocadoBrussel SproutsCauliflowerRed CabbageCabbageCeleryGreen PeesCollard GreensCornPickle (dill)Endive (raw)Cucumber (w/o peel)Lettuce (iceberg)Kale (raw, leaf)EggplantLettuce (bib, red leaf)MushroomsMustard Greens (raw)OnionsParsleyGreen pepperSpinachPotatoTurnip Greens (raw)PumpkinWatercress (raw)Sauerkraut (canned)Swiss ChardTomatoFruitsAppleBananaBlueberriesGrapesOrangeMeats/FishBeefChickenPorkTunaTurkeyFats/OilsCorn OilMargarineMayonnaisePeanut OilOlive OilCanola OilSafflower OilSoybean OilSesame OilSunflower OilDairy ProductsButterCheese (cheddar)EggsSour CreamYogurtBeveragesCoffeeGreen TeaColaTea, BlackMilkFruit Juices   SHAPE \* MERGEFORMAT  Coumadin Interactions with Medications Increase the effects of Coumadin Acetaminophen (Tylenol) Amiodarone (Cordarone) Anabolic Steroids Cimetidine (Tagamet) Ciprofloxacin (Cipro) Disulfiram (Antabuse) Erythromycin Fluconazole (Diflucan) Influenza Vaccine Isoniazid (Nydrazid) Itraconazole (Spranox) Lovastatin (Mevacor) Metronidazole (Flagyl) Non-Steroidal Anti-Inflammatory Norfloxacin (Noroxin) Ofloxacin (Floxin) Omperazole (Prilosec) Phenytoin (Dilantin) Propafenone (Rythmol) Propranolol (Inderal) Propoxyphene (Darvon) Quinidine Salicylates Tamoxifen (Nolvadex) Tetracycline Thyroxine Trimethoprim/Sulfamethoxazole (Bactrim)Decrease the effects of Coumadin Azathioprine (Imuran) Barbiturates Carbamazepine (Tegretol) Cholestyramine (Questran) Cyclosporine (Sandimmune) Dicloxacillin (Dynapen) Griseofulvin (Grisactin) Nafcillin Rifampin (Rifadin) Sucralfate (Carafate) Trazodone (Desyrel) Adapted from Prescribers Letter: www.prescribersletter.com  SHAPE \* MERGEFORMAT  Anticoagulation Management: Patient Agreement Plan This document is a contract between ________________________ (__/__/____) and Northwest Community Healthcare Medical Group and has been designed to inform you of the important points of managing your anticoagulant medication By signing this contract, I agree to the following: I am required to be present at all anticoagulation visits. If I am unable to make my appointment, I will call the office beforehand and reschedule. I will take my anticoagulation medication only as prescribed by the healthcare clinician. This includes taking the medication at the same time each evening. I will notify the healthcare clinician if I miss a dose of my medication and it has been more than 8 hours. I will inform all treating healthcare providers and clinicians I am taking an anticoagulant medication. I will contact the healthcare clinician before following any medication instructions by another provider. I will notify the healthcare clinician if I am scheduled for any procedures such as dental work, gum bleeding, unusual bruising or bleeding, blood in stool, urine, vomit or sputum. I will notify the healthcare clinician if I am going out of town for any length of time and arrangements will be made to have my INR checked while I am gone. I will notify the healthcare clinician if there are any changes in medications (prescription or non-prescription) I am taking or if I start any new medications (prescription or non-prescription). I will notify the healthcare clinician if I change any eating habits. This includes changes in food intake (increase or decrease) and foods with carrying amounts of Vitamin K. I am taking a medication that must be followed closely in order to protect me from any complications. I understand that noncompliance with any of the above can result in serious health risks. I have read this document and understand the information and its importance. I understand the contract and know that I am responsible for assisting my healthcare providers and clinicians in managing my health. I will abide by the terms of this agreement. Failure to do so will impact the effective management of this medication. ________________________________ _____________________ Patients Signature Date ________________________________ _____________________ Clinicians Signature Date  INCLUDEPICTURE "http://nchmedicalgroup.com/images/1.jpg" \* MERGEFORMATINET  Table 1 - Recommended Target INRs IndicationTarget INRProphylaxis of venous thrombosis (high risk surgery) Treatment of DVT or PE Prevention of systemic embolism: Atrial fibrillation Tissue heart valves Valvular heart disease Mechanical bileaflet or tilting disk valve in aortic position Prevention of recurrent MI (with concurrent ASA) Cerebral venous sinus thrombosis Ischemic stroke due to aortic arch thrombus2.0-3.0Mechanical prosthetic heart valves (high risk) Recurrent systemic embolism Left atrial thrombus2.5-3.5Thrombosis of mechanical valve in aortic position2-3Thrombosis of mechanical valve in mitral position Thrombosis of mechanical valve aortic + mitral 2.5-3.5   INCLUDEPICTURE "http://nchmedicalgroup.com/images/1.jpg" \* MERGEFORMATINET  Anticoagulant Clinic Objective: To provide a strategy for the management of warfarin therapy in ambulatory adult patients using a standardized process while offering an individualized assessment. Interventions and Practices Considered: This guideline provides strategies and recommendations designed to assist clinicians in developing warfarin management plans. It begins with providing recommendations for target INR ranges based on indication for use. It focuses on how to dose warfarin based on individual patient risk factors, INR response, drug interactions, and dietary interactions Initial Warfarin Dose Patient ConditionInitial DoseInitial dose5 mg/ dailyWeight less than 120 lb. Liver disease2.5 mg/daily INR Checks after Initiation of Warfarin Testing FrequencyEvery 2-3 day to weekly (RN discretion)Until INR within therapeutic range on 2 consecutive INR checks Then every weekUntil INR within therapeutic range on 2 consecutive INR checksThen every 2 weeksUntil INR within therapeutic range on 2 consecutive INR checksThen every 3 weeksUntil INR within therapeutic range on 2 consecutive INR checksThen every 4 weeksWhen dose is stable check monthly  INCLUDEPICTURE "http://nchmedicalgroup.com/images/1.jpg" \* MERGEFORMATINET  Dose Adjustment and Coumadin Management Algorithm For best practice of Coumadin management, healthcare clinicians who manage oral anticoagulation therapy should do so in a systemic and coordinated fashion, incorporating patient education, systematic INR testing, tracking, follow-up and good communication of results and dosing decisions For target INR of 2.0-3.0 and no bleeding: INR<1.51.5-1.92.0-3.03.1-3.94.0-4.54.5-8INR >10Dose AdjustmentRecheck INR using a different finger; Increase weekly dose 10-20%; consider extra dose Recheck in 3 daysConsider an extra dose or Increase weekly dose 5-10%(*)No change if stable (**)If >3.5 Consider holding a dose or decrease weekly dose 5-10% INRs 4.5 or higher recheck INR using a different finger Consider Hold for 0-1 day then decrease dose 10%Notify doctor. Recheck INR using a different finger if INR > 8.0 or if doctor request a lab draw to confirm reading. Hold for 2-3 days and consider then decreaseing weekly dose 10-20%Hold 1 day Order Vitamin K 5 mg po at Pharmacy Inform MD Check INR next day Report any signs of bleeding and bruising (*) For patients with previously stable INRs who present with a single out-of-range INR of <0.5 below or above therapeutic, consider continuing current dose and testing INR in 7-14 days (**) If INR is 2.0-3.0 and patient is not stable, consider change in dose with repeat INR in 3-5 days For target INR of 2.5-3.5 and no bleeding: INR<1.51.5-2.42.5-3.53.6-4.54.5-108INR >10Dose AdjustmentRecheck INR using a different finger; Increase weekly dose 10-20%; or consider extra doseIncrease weekly dose 5-10%(***) or consider an extra dose.No change if stable(****)Decrease weekly dose 5-10%; consider holding one dose(***)Notify doctor if > 4.5 Recheck INR using a different finger: If INR > 8 or if doctor requests a lab draw to confirm reading. Hold for 1-2 days then decrease weekly dose 5-15%Hold 1 day Order Vitamin K 5 mg po at Pharmacy Inform MD Check INR next day Report any signs of bleeding and bruising (***) For patients with previously stable INRs who present with a single out-of-range INR of <0.5 below or above therapeutic, consider continuing current dose and testing INR in 7-14 days (****) If INR is 2.5-3.5 and patient is not stable, consider change in dose with repeat INR in 3-5 days  INCLUDEPICTURE "http://nchmedicalgroup.com/images/1.jpg" \* MERGEFORMATINET  Management of Elevated INR with Vitamin K Vitamin K will be given for patients with a high bleeding risk at the discretion of the managing physician or those who need quick reversal such as before surgery If INR > 10 repeat with a lab draw to confirm reading. Hold dose. ,Report signs of bleeding and bruising consult doctor. DO NOT use subcutaneous Vitamin K as its absorption is less predictable and can cause a severe allergic reaction. (anaphylaxis) Oral Vitamin K should only be given with a doctors order For serious bleeding, call 911 and transfer to hospital. Dose adjust should be considered after thorough evaluation of patients dosing history, short/long term changes in medications and/or short/long term changes in diet and supplement use. These adjustments should be documented in the EMR.  INCLUDEPICTURE "http://www.nchmedicalgroup.com/images/1.jpg" \* MERGEFORMATINET  Coumadin Dosage Calendar Date ______________________ Todays INR ________________ Next Appointment __________________________ Please take your Coumadin as follows: MondayTuesdayWednesdayThursdayFridaySaturdaySunday  COAGUCHEK XS PATIENT TEST LOG Test Strip Lot # Exp Date: Meter Serial #Date/TimeTwo Patient Identifiers (Name/DOB/MRN#)Controls OK (")Test ResultCommentTest Performed By:                COAGUCHEK XS MUST BE CLEANED AFTER EVERY PATIENT AND AT THE END OF EACH DAY (DOCUMENT IN COMMENTS) RETAIN RECORDS FOR TWO YEARS  Coumadin Protocol Training Checklist Name: ____________________________________ Date: _______________ EMR Coumadin Documentation Training Goal: to provide training and to demonstrate competence in the performance of completing a Coagulation Clinic Chart Note Objective Trainer InitialsDateDemonstrate opening of Coagulation Clinic Chart NoteDemonstrate ordering of Coagulation PanelKnow what and how to fill in required fieldsConfirm the patients current doseConfirm the INR obtained matches what was chartedKnow how to order Coumadin Panel for future dateConfirm all information entered is correct Know how to electronically sign chart note This certifies that: ____________________________________ (signature) has completed the training for EMR Coumadin Documentation, has demonstrated acceptable performance of documentation and is competent to complete the Coagulation Clinic Chart Note. Trainer: _______________________________________ Date: _____________ Place completed checklist in employees file  Coumadin Protocol Training Checklist Name: ____________________________________ Date: _______________ Coagucheck XS Device Training Goal: to provide training and to demonstrate competence in the performance of the Coagucheck XS Device ObjectiveTrainer InitialsDateRead the package insert and user manualDemonstrate understanding that manufacturers instructions must be followed exactlyKnow the storage requirements and handling of the Coagucheck XS device test stripsKnow how to set date/timeConfirm the code number on the test strip container and the code chip in the meter matchKnows how to change code chip when appropriateVerbalize understanding of built-in control included with each patient testDemonstrate competency by performing at least one control or patient test. Verify the code displayed on the meter matches the code number on the test strip containerKnow frequency and how to clean meter exterior and meter test strip guideUnderstand the test result range of the meterKnow how to trouble-shoot error messagesKnow who the primary contact is for trouble shooting This certifies that: ____________________________________ (signature) has completed the training for the Coagucheck XS Device, has demonstrated acceptable performance of the test, and is competent to use the Coagucheck XS Device. 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