Massachusetts General Hospital Massachusetts General Hospital Anticoagulation Management ServiceAnticoagulation Management Service

Using Dawn AC to Support Safe Management Using Dawn AC to Support Safe Management of Anticoagulated Patientsof Anticoagulated Patients

Lynn B. Oertel, MS, ANP, CACPLynn B. Oertel, MS, ANP, CACPClinical Nurse SpecialistClinical Nurse Specialist

Presented November 4, 2008

Dawn AC Front ScreenDawn AC Front Screen

Moving into the 21th CenturyMoving into the 21th Century

List ViewsList Views

Daily work organized and sorted with use of these listsDaily work organized and sorted with use of these lists Customizable lists and filters determine what patient data is Customizable lists and filters determine what patient data is

displayeddisplayed Bulk messaging can be accomplishedBulk messaging can be accomplished

Clinic DiariesClinic Diaries

Helps manage/direct future daily workHelps manage/direct future daily work Controls INR scheduling for weekends, holidays, Controls INR scheduling for weekends, holidays,

days off, etc.days off, etc.

ReportsReports

Customized reports (data viewed/printed from Customized reports (data viewed/printed from screen or easily exported into MS Excel for further screen or easily exported into MS Excel for further analysis)analysis)

Benchmarking optionBenchmarking option

AMS Note placed in hospital electronic AMS Note placed in hospital electronic medical record whenever an AMS medical record whenever an AMS

patient is admittedpatient is admitted

Key Elements:

•INR Intensity range•Duration of therapy•Pill Size•Current and last 4 INRs/dose instructions•Brief medical details•Contact information

ADT Interface: ADT Interface: Real time update with Real time update with hospital census & AMS patient populationhospital census & AMS patient population

When patient is discharge, patient’s name appear on discharge filter.

AMS RN follows standard procedures for follow-up and confirmation of the treatment plan.

Lab Results Interface: timely and Lab Results Interface: timely and more accurate INR recordsmore accurate INR records

Bridging and Induction patients Bridging and Induction patients electronic recordselectronic records

Facilitate timely hand-off toFacilitate timely hand-off tooutside physicianoutside physician

Letter confirms follow-up appointment and identifies: pill size, recent dose and INR response history, Lovenox info, need for new warfarin Rx

Computerized Dosing SupportComputerized Dosing Support

Dose management settings can be Dose management settings can be customized to user specifications customized to user specifications (system wide and at individual (system wide and at individual patient level)patient level)

INR and dose communication INR and dose communication primarily done by US Postal Mail via a primarily done by US Postal Mail via a dose instruction letter (options dose instruction letter (options include email/fax/phone)include email/fax/phone)

Treatment PlanTreatment Plan

Future release of Dawn AC (7.7)Future release of Dawn AC (7.7)

•Improved presentation

•Single or multiple tablet strengths or Mg

•Image or text denotes mg strength

•Optional calculated total mg

•Revised INR Hx area – makes better use of space

Enhancement of induction or bridge Enhancement of induction or bridge therapy documentationtherapy documentation

Results with Transition PathwaysResults with Transition Pathways

Transition PathwaysTransition Pathways(seamless transition from in to out patient world)(seamless transition from in to out patient world)

Consult Referral Order for Anticoagulation Consult Referral Order for Anticoagulation Management Services placed in Physician Management Services placed in Physician Order Entry systemOrder Entry system• Order processed by AMS secretaries and Order processed by AMS secretaries and

handed off to a nursehanded off to a nurse• Nurse reviews and makes inpatient visit to Nurse reviews and makes inpatient visit to

patient. patient. AMS begins management day after AMS begins management day after

dischargedischarge Formal face-to-face educational session Formal face-to-face educational session

scheduled with nurse approx. 7 – 10 days scheduled with nurse approx. 7 – 10 days after dischargeafter discharge

Impact of transition pathwaysImpact of transition pathways

95-100% of AMS-referred patients 95-100% of AMS-referred patients meet ACCP overlap guidelinesmeet ACCP overlap guidelines

70% of INRs measured at first 70% of INRs measured at first appointment after discharge in appointment after discharge in therapeutic rangetherapeutic range

Significant reduction in hospital Significant reduction in hospital length of stay (~ 4.63 days)length of stay (~ 4.63 days)

Patients express high satisfactionPatients express high satisfaction

MGH/AMS 2005