Friday, July 23, 2004
This presentation is part of : Health Informatics
A Nurse Practitioner-Managed Virtual Chronic Anticoagulation Clinic
Laura K. Heermann Langford, PhD, RN, Medical Informatics, Medical Informatics, Intermountain Health Care, Salt Lake City, UT, USA
Learning Objective #1: Describe the methodology for a nurse-practitioner managed virtual chronic anticoagulation clinic
Learning Objective #2: Describe how an integrated database with decision support can be applied to patient care

Overview of Problem: Warfarin is used to chronically anticoagulate patients for a variety of indications, both therapeutic (e.g. treating DVT/PE) and prophylactic (e.g. preventing stroke in-patients with artificial valves). However, warfarin has a narrow therapeutic window and problems with everyday management of coagulation may lead to detrimental side effects. Usually patients who receive anticoagulation therapy are managed by their primary care physician (PCP). The management of this medication, its therapeutic levels, and complications is time intensive for all physicians. A virtual clinic managed by a nurse practitioner allows for more efficient management and more timely follow up of patients receiving chronic anticoagulation therapy.

Methods: A virtual clinic staffed by a Nurse Practitioner (NP) and a certified nursing assistant (CNA) monitor INR lab results of CAC patients via a centralized clinical database with integrated decision support. Patient’s submit to blood draws at any lab associated with the healthcare corporation. Standardized rules are applied to each INR lab result of CAC patients assigning the result to one of 8 “zones” indicating if the INR is higher or lower than normal and if abnormal, how far out of range. Actions taken by the NP or CNA’s depend on the zone assigned which range from re-draw an INR level in one week to medication adjustments or in severe cases administration of Vitamin K or other emergent actions.

Findings: The CAC is staffed by 0.5 FTE plus call time by a NP and 1.0 FTE of CNA time. The clinic consists of 674 chronically anticoagulated patients. Early data shows these patients to be within therapeutic range 53.4% of the time.

Conclusions: Management of chronic anticoagulation therapy via a virtual clinic staffed by an NP and CNA is possible and effective, thus relieving PCP’s of this time consuming and tedious task.

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