Title slideGeorgia Hospital Engagement Network

Healthcare Acquired Condition Affinity GroupJune 19, 2013

Presenter: Dr. Teresa Pounds, PharmD, BCNSP

Moderator: Tracy Rutland, RT(R), MBA/MHA HAC Affinity Lead

ANTICOAGULATION PERFORMANCE

IMPROVEMENT INITIATIVES

Dr. Teresa Pounds, PharmD, BCNSP

ObjectiveShare strategies employed at AMC to

decrease international normalized ratio - INR related adverse drug events – ADE via the following:

Information Technology (IT)Efficient Utilization of Pharmacy

ResourcesConcurrent INR MonitoringPatient Safety Committee

Involvement

BackgroundAtlanta Medical Center has been successful in its ability to avoid adverse drug events (ADE) associated with the use of anticoagulants such as warfarin.

Due to the dedication of the pharmacy department in ensuring that patient safety is prioritized first while providing the best pharmaceutical care to its patients.

Points For Discussion Information Technology (IT)

Efficient Utilization of Pharmacy Resources

Concurrent INR Monitoring

Patient Safety Committee Involvement

2- Year Snapshot

Information Technology (IT)Pharmacy collaborated with IT to

generate a daily INR reportINR > 4 report

Report automatically prints first thing in the morning

INR drill down Involves the investigation of INRs > 3 Outpatient vs inpatient incident of elevated

INR Appropriate induction dose of warfarin Drug/food associated interactions

Daily INR Report

Efficient Utilization of Pharmacy Resources Decentralized clinical pharmacists

Performs INR drill down Intervenes where necessary

Pharmacy residents Performs INR drill down Intervenes where necessary

4-yr students Performs INR drill down Reports the information to a decentralized

clinical pharmacist and pharmacy resident

Concurrent INR monitoringClinical pharmacist at point of

order entry and pharmacy residents

Ensures the ordering of initial INR prior to warfarin

Daily INR monitoring of patients on warfarin 4-th year pharmacy students perform these as

well Appropriate intervention as indicated

Concurrent INR Monitoring cont’dStaff education on improved

methods of counseling the warfarin patientuse of warfarin teaching guidepresence of pyxis prompts ensure

that nurses verify patients INR prior warfarin administration

Reporting StructureAnticoagulation subcommittee

co-chaired by Dr. Pounds with representatives such as : PhysiciansNursesPharmacistsDietitiansRisk managementIT

Reporting Structure cont’dPatient Safety Committee (PSC)

Ensures accountability amongst parties responsible for daily INR monitoring

Monthly report sent to PSC PI indicators

RESULTSTotal Percent (%) of Patients achieving super-therapeutic INR levels (>4) while receiving warfarin (Coumadin®) therapy (Goal: <5)

AUGUSTSEPTEMBER0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00% 5.30%

2.74%2.40% 2.50%

20102012