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Anticoagulation
QUICK LINKS: Epic AMS Tip Sheet | Patient Education | Toolkit | Warfarin Guides



Special Issue: Management of Venous Thromboembolism: Clinical Guidance from the Anticoagulation Forum
Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J. Guidance for the practical anagement of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis. 2016 Jan;41(1):206-32. click here

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M,King CS, Morris TA, Sood N, Stevens SM, Vintch JR, Wells P, Woller SC, Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016 Feb;149(2):315-52 click here


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.

ACE logo

 

 

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

 

CACP logo

 


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

 

MGH NARRATIVES

 Ann Quealy, RN     

Palmie Riposa, RN, staff nurse,
Anticoagulation Management Service

AN MGH NARRATIVE

Primary nursing
a kaleidoscope of intimate moments with
patients and families

more...

 

 

 


 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.

Jan-Mar 2015
Actual
97.75%
Target
100.00%

 

Apr-Jun 2015
Actual
97.91%
Target
100.00%

 

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

July-Sept 2015
Actual
74.73%
Target
70%

 

Apr-Jun 2015
Actual
73.82%
Target
70%

 

IN THE NEWS

There are now four new oral anticoagulants approved by the FDA for NVAF and VTE Treatment.

  • Dabigatran (Pradaxa)
  • Rivaroxaban (Eliquis)
  • Apixaban (Eliquis)
  • Edoxaban (Savaysa)

Special Issue: Management of Venous Thromboembolism: Clinical Guidance from the Anticoagulation Forum
Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J. Guidance for the practical anagement of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis. 2016 Jan;41(1):206-32. click here

Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M,King CS, Morris TA, Sood N, Stevens SM, Vintch JR, Wells P, Woller SC, Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016 Feb;149(2):315-52 click here

Praxbind - FDA approves reversal agent, idarucizumab (Praxbind), for dabigatran (Pradaxa) click here for more  

Medical errors in Mass. Still common, study findsThe Boston Globe (12/2/14)

Mass. Hospitals’ mistakes list widensThe Boston Globe (8/14/14)

Stop the Clot®
Creating new avenues to inform patients and families about blood-clot prevention
Caring Headlines (11/21/13)

FDA expands use of Xarelto to treat, reduce recurrence of blood clots—FDA (11/2/12)

TOOLKIT
AMS button

HealthStream ( internal access only)
In Healthstream search the catalog using 'AMS icon" to locate the Healthstream course.
Click here to be taken to Healthstream

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

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

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

DOAC Reference at a Glance click here

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

Summary and Comparison for Patient Education for Anticoagulants  click here

Primary nursing: a kaleidoscope of intimate moments with patients and familiesCaring Headlines (1/21/10)

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

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.

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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:

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 3/15/17

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