WWW Iowa Healthcare Collaborative

Anticoagulation

IHC, in cooperation with health care providers across the state, has developed the following Anticoagulation Toolkit. The toolkit is a compilation of resources to ensure effective and safe long-term anticoagulation therapy.

We would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors. Please contact IHC if your organization would like to contribute materials to this toolkit.
  • Allen Memorial Hospital Anticoagulation Clinic, Waterloo, IA
  • Central Community Hospital, Elkader, IA
  • Community Anticoagulation Therapy (CAT) Clinic, Cedar Rapids, IA
  • Great River Medical Center, Burlington, IA
  • Guttenberg Hospital Anticoagulation Therapy Program, Guttenberg, IA
  • Madison County Anticoagulation Management Clinic, Winterset, IA
  • Mercy North Iowa, Mason City, IA
  • University of Iowa Hospitals and Clinics, Iowa City, IA
  • Veterans Administration Medical Center of Central Iowa, Des Moines, IA
  • Veterans Administration Medical Center, Iowa City, IA
  • Winneshiek Medical Center, Decorah, IA
Project Description


Tool Kit

The National Quality Forum (NQF) in Safety Objective #29 states that “Every patient on long-term oral anticoagulants should be monitored by a qualified health professional using a careful strategy to ensure an appropriate intensity of supervision.”(1) NQF goes on to outline explicit organizational policies and procedures necessary for effective management of patients taking anticoagulants.(1) The IHC Anticoagulation Work Group has endorsed NQF's recommendations. The Work Group has divided these recommendations into an easy step-by-step process. Below are organizational policies, procedures, forms and flowsheets that align and satisfy each recommendation.

Step 1: Policies and Procedures

Explicit organizational policies and procedures should be in place regarding anti-thrombotic services that include at least documentation of:
  • Indication for long-term anticoagulation
  • Target INR range
  • Duration of long-term anticoagulation and/or a review date
  • Timing of the next INR appointment
Below are policies and procedures that satisfy these requirements.

Intake/Indication for long-term anticoagulation
Policies, procedures, and forms, to document patient intake and indication for long-term anticoagulation therapy.


Target INR Range and Dosing Policies
Below are tables, policies, procedures, and forms to effectively monitor and document target INR and dosing. Note the Anticoagulation Work Group endorses the use of the American College of Chest Physician's Guidelines for therapeutic target INR.(2)


Duration of long-term anticoagulation and/or a review date
Policies, procedures, flowsheets and forms to document duration of long-term anticoagulation and/or review date.


Timing of the next INR appointment
Organizational policies and procedures to effectively document and monitor timing of the next INR appointment.



Step 2: Staff Education

To ensure that long-term (anticoagulation) therapy is effective and safe, every patient should be monitored by a qualified health professional. To this end, IHC has compiled a list of employment protocols, job descriptions, and continuing education programs for health care professionals who want to develop the knowledge and skills necessary for effective, coordinated anticoagulant therapy management. Below please find on-line and in-person anticoagulation therapy certification programs endorsed by the ACforum.



Step 3: Reliable Patient Scheduling and Tracking

Below are forms, procedures, and policies to aid in the implementation of reliable patient scheduling and tracking.



Step 4: Patient Engagement and Compliance

Below are policies, procedures, and forms to facilitate patient engagement and compliance.



Step 5: Discharge Planning/Patient Education

Discharge planning and patient education should include 1) specific verbal and written patient education materials appropriate for each patient's language and reading level with assessment of understanding; and 2) bridging therapy across care setting transitions. Below are discharge tools and patient education materials utilized by anticoagulation clinics across Iowa that satisfy these requirements.

Discharge Planning


Patient Education


Complete Policies
Below are complete policies from Iowa anticoagulation clinics containing all criteria necessary to run an effective long-term anticoagulation therapy program(Consultation and referral, appointment scheduling, clinic procedure, laboratory procedure, patient education, etc.)


Miscellaneous


References:
(1) www.qualityforum.org
(2) Chest Vol 126, Supplement, September 2004, www.chestjournal.org/content/vol126/3_suppl/




Success Stories


How to Promote



Business Case




Mentor Hospitals

Allen Memorial Hospital Anticoagulation Clinic, Waterloo, IA

Central Community Hospital, Elkader, IA

Community Anticoagulation Therapy (CAT) Clinic, Cedar Rapids, IA

Great River Medical Center, Burlington, IA

Guttenberg Hospital Anticoagulation Therapy Program, Guttenberg, IA

Madison County Anticoagulation Management Clinic, Winterset, IA

Mercy North Iowa, Mason City, IA

University of Iowa Hospitals and Clinics, Iowa City, IA

Veterans Administration Medical Center of Central Iowa, Des Moines, IA

Veterans Administration Medical Center, Iowa City, IA

Winneshiek Medical Center, Decorah, IA


Resources

Websites

DVT Anticoagulation Software Stroke *Codes
D: DVT Site
A: Anticoag Site
P: Patient-Specific Site
M: Medical / Health Care Professional Site
PM: Patient or Medical Site




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Detail Navigation

  • Toolkits Front Page

    View the toolkits IHC will deploy in 2006 and their contents.

  • Anticoagulation

    Resources for providers to ensure safe and effective long-term anticoagulation therapy in all care settings.

  • Culture of Safety

    Information on how to deploy the NQF 30 Safe Practices.

  • Health Literacy

    Information that discusses how to better communicate medical information to patients.

  • Healthcare-associated Infections

    Information on the monitoring and reporting of HAIs.

  • Lean in Health Care

    This process improvement method can help providers deliver more efficient care that saves resources and improves quality.

  • Medication Reconciliation

    Resources for providers to avoid adverse drug events.

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