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. The three validated survey instruments built into AC include the following:
Each of them can be completed initially or updated by the clinician while they are with a patient and scored accordingly. If results indicate the patient is at risk, the risk badge on the left hand side of the screen with the patient summary information will be turned red for easy identification.
*Note the ease of access to the validated survey instruments in the following screen shot:
Evidence Based Guidelines to Support Dosing Decisions
Industry best practices are built into AC. One of those best practices is the Hamilton Nomogram enabling auto dosing guidelines for warfarin medication plans. The Hamilton Nomogram will recommend a dosing schedule for patients based on the dosing specific information collected regarding a patient’s health.
However, when you select ‘Automatic Dosing Capabilities’, certain selection criteria must be met while using the auto-dosing feature to ensure adherence to the industry guidelines. For example:
- Keep in mind that the therapy stage must be in maintenance
- There should be at least 30 days since the initial INR reading
- At least 3 consecutive INRs in the target range and 3 consecutive pill schedules using single week auto dosing pill sizes
- Also, you may get an alert if the patient has not been compliant with their previous schedule
These parameters are required and ensure the integrity of the Hamilton Nomogram dosing schedule recommendations. Clinicians always have the ability to switch from ‘Auto Dosing’ back to ‘Manual Dosing’ as clinicians know their patient’s situation best and may elect to see the recommendations of the evidence-based guideline and still enter an adjust schedule based on their intimate knowledge of their patient’s health considerations.
A screen shot of the auto dosing capabilities follows:
The purpose of this article was to demonstrate that outcomes can be objective and easily understood in context to increase the clinician’s ability to draw on specific data relevant to the care plan for a patient they are meeting with at the moment without searching for all the disparate information to be brought together.
Tell us how you and your team identify risks with your anticoagulation patients in the comment section below.
Also,look for more information coming soon from Jennifer Glen, our VP of Clinical Services, to tie the information shared here with meaningful use and MIPS metrics your organization can leverage to demonstrate your effectiveness as a provider of care services.