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Anticoagulation
QUICK LINKS: Patient Education | Toolkit | Warfarin Guides

AMS logo

An estimated 3-4 million Americans are on anticoagulants in order to treat or prevent blood clots. Oversight and education by expert clinicians can help these patients avoid bleeding or clotting.

The MGH Anticoagulation Management Service (AMS) is among the nation’s oldest and largest anticoagulation clinics.  Established in 1969 in cardiology, the Anticoagulant Therapy Unit (ATU – as it was known then) traditionally focused on the outpatient management of warfarin therapy. In 1972, the ATU became fully computerized, including use of a computerized decision support tool for dosing warfarin and scheduling blood tests. In 1982, the first registered nurse was hired. In 2005, a strategic decision was made to move the ‘old’ ATU into the Department of Nursing.  A new name was added, the AMS, to reflect more than just warfarin management. Today the AMS has a team of 15 nurses and 5 administrative support personnel in order provide comprehensive education and management to nearly 4500 patients on warfarin therapy.

AMS buttonTips for Best Practice (internal access only)     AMS Overview & History


Norman Knight Center logo

Anticoagulation in 2015:  Safety and Transitions of Care Issues
February 13, 2015 from 8 AM – 4:30 PM
O’Keeffe Auditorium

Offered by The Normal Knight Nursing Center for Clinical & Professional Development.

This full-day course will focus on anticoagulation safety, particularly during transitions of care.
Case-based presentations will be used to illustrate optimal drug management in patients with atrial fibrillation and venous thromboembolic diseases. Topics will include:  Overview and impact of atrial fibrillation and venous thromboembolic disease in the US;, pharmacological aspects of new target specific oral anticoagulants; discussion of transitions of care delivery environments and among drug therapies; and patient education practice pearls.
For more information or to register
click here.


ACE logo

 

 

MGH AMS recognized by Anticoagulation Forum as a Center of Excellence more...

 

CACP logo

 


Seven MGH staff RNs have achieved national Anticoagulation Care Provider (CACP) credentialing

 

AN MGH NARRATIVE

 Ann Quealy, RN     

Ann Quealy, RN, former staff nurse, clinical scholar Anticoagulation Management Service

AN MGH NARRATIVE

Earning trust is first step in patient-focused
care for AMS nurse

"Mary is a 59-year-old woman who is taking warfarin because she has anti-phospholipid syndrome with underlying systemic lupus erythematosus. It is an auto-immune disorder characterized by anti-phospholipid antibodies in the blood, and it is associated with excessive clotting." more...

 

 

THE DATA

Completion of INRs every 28 days

College of Chest Physicians advocates full compliance, whenever possible, with INR monitoring.  THE MGH AMS established a goal of 100% compliance.

Time in Therapeutic Range

The American College of Chest Physicians, based on data largely from the atrial fibrillation trials, recommends a target over 65-70%.  The MGH AMS consistently outperforms the target goal

Policies, Procedures & Guidelines:
(internal access only)

Anticoagulation Clinical Guidelines

Apr-Jun 2014
Actual
98.04%
Target
100.00%

 

Jan-Mar 2014
Actual
97.43%
Target
100.00%

 

Apr-Jun 2014
Actual
73.43%
Target
70%

 

Jan-Mar 2014
Actual
73.43%
Target
70%

Antithrombotic Medications Stewardship Committee:
Meets: 3rd Thursday monthly
3:00 - 4:00pm

 

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IN THE NEWS
TOOLKIT

E-Z Guide to Complete AMS referral

E-Z Guide for Optimizing Warfarin

AMS button

HealthStream ( internal access only)
MGH AMS Icon and Anticoagulation Safety

Patient Self Testing
"Is patient self-testing a good thing?" Journal of Thrombosis and Thrombolysis

MGH AMS Patient compliance with INR blood testing
Oertel LB, Libby EN. Is patient self-testing a good thing?  J Thromb Thrombolysis .  2010: 29:214-218  DOI 10.1007/s11239-009-0414-3

Supporting patient compliance
"Practical management approaches to anticoagulation non-compliance, health literacy, and limited English proficiency in the outpatient clinic setting"
Journal of Thrombosis and Thrombolysis
Seliverstov I.  Practical management approaches to anticoagulation non-compliance, health literacy, and limited English proficiency in the outpatient clinic setting.  J Thromb Thrombolysis. 2011: 31:321-325  DOI 10.1007/s11239-011-0560-2

Anticoagulation Clinical Guidelines (internal access only)

MGH Contacts:

  Lynn B Oertel, MS, ANP, CACP
  loertel@partners.org
  617-726-6955, pager # 34150      

OTHER RESOURCES

bloodClick here to view YouTube videos from the patient education conference, sponsored by "Stop the Clot," produced by the National Blood Clot Alliance through a cooperative agreement with the Centers for Disease Control and Prevention (CDC).

  • Are You At Risk For Blood Clots (presented by Jack Ansell, MD)
  • All About Blood Clot Treatment and Prevention (presented by Michael Jaff, DO)
  • Patient Experiences with Blood Clots (presented by Diane DeTour, RN and MGH AMS patients)
  • Practical Safety Tips about Blood Th8inners (presented by Katherine Cabral, PharmD)

Staying Active and Healthy: Blood Thinners—an AHRQ Educational video


PATIENT EDUCATION

Medication Education

MGH AMS Patient & Family Education Slideshow click here

Partners Handbook click here

Disease-Specific Education

Atrial Fibrillation—a series of short animated slides from American Heart Association

Preventing Blood clots—video by the University of Michigan Health System

Heart Valve information—interactive tutorial by Medline Plus

 

 


WARFARIN:

A Guide to Taking Warfarin

All Guides above MUST be printed in COLOR.
Please call the Maxwell & Eleanor Blum Patient and Family Learning Center at 617-724-7352 if you need these documents printed.

EXTERNAL REVIEWERS
Joint Commission logo

National Patient Safety Goal

The Joint Commission issues Sentinel Event Alerts to inform health care organization of potential patient safety risks.   During the 1990’s, several randomized, clinical trials clearly demonstrated the benefit and safety of using warfarin to prevent embolic strokes in patients with non-valvular atrial fibrillation (AF).  As a result, we have experienced a large increase – which continues to grow at a fast rate – in the number of Americans with AF who need oral anticoagulation.  Anticoagulants are considered “high risk” medications because of the potential harm if not managed properly.

The Joint Commission began receiving voluntary reports from hospitals about the patient harm related to the use of anticoagulants. As a result there have been two Sentinel Event Alerts published on this topic.  These alerts have been the guidance documents for creating safer systems to keep patients safe from harm:

High Alert Medications

Preventing Errors from Commonly Used Anticoagulants

 

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhancing patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

 

 

 

 

 

 

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GLOSSARY OF TERMS
There are numerous terms and acronyms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: Anticoagulant

Drug used to prevent clot formation or to prevent a clot that has formed from enlarging. Anticoagulant drugs inhibit clot formation by blocking the action of clotting factors or platelets. Anticoagulant drugs fall into three groups: inhibitors of clotting factor synthesis, inhibitors of thrombin and antiplatelet drugs. The FreeDictionary (accessed Dec. 2, 2014)
Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

updated 12/8/14

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