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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.
Collaborative Governance Magnet Recognition Regulatory Readiness Innovation Units

Other Topics: Anticoagulation | CAUTI | Central Lines | Diversity | Downtime (internal access only)

Ethics | Evidence-Based Practice | Fall Prevention | Pain | Patient Education/Health Literacy | Patient Experience
Practice Alerts & Updates (internal access only) | Pressure Injuries | Process Improvement | Professional Development | Restraints
SUD | Workplace Violence (internal access only) | EED Home

Epic Documentation | Epic Communication

(internal access only)|

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



 Ann Quealy, RN     

Palmie Riposa, RN, staff nurse,
Anticoagulation Management Service


Primary nursing
a kaleidoscope of intimate moments with
patients and families





 Ann Quealy, RN     

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


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...




Did you know?   1 in 4 people worldwide are dying from conditions caused by thrombosis. And, it's a startling fact that up to 900,000 people in the United States alone are affected by blood clots each year; about 100,000 of those people will die, which is greater than the total number of people who lose their lives each year to AIDS, breast cancer, and motor vehicle crashes combined.

World Thrombosis Day

For more information about World Thrombosis Day, visit

At MGH, visit our educational table in the Main Corridor on Wednesday, October 10, 2018, 8am – 1pm,
to learn more!


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

Use of direct oral anticoagulants for stroke prevention in elderly patient with nonvalvular atrial fibrillation
Lynn B. Ortel, MS, NP-BC, CACP (Nursing Practice Specialist & Annmarie E. Fogerty, MD (Internist) Read article

DOAC Reference at a Glance click here

DOAC Potential Drug Interactions click here

MGH Contacts:

  Lynn B Oertel, MS, ANP, CACP
  617-726-6955, pager # 34150      


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


Medication Education

MGH AMS Patient & Family Education Slideshow for WARFARIN 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)

Patient Education Presentations

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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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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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

updated 3/15/17

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