A Pharmacy/Nurse/MD Solution - NYS Partnership for Patients

Improving AnticoagulationManagement:A Pharmacy/Nurse/MD SolutionSteve DiCrescento, BPharm, MSFebruary 2013

What is PIGFARM?• Problem – clearly stated• Importance of problem, why focus on this?• Goal setting – where are we headed?• Fact-finding – root causes, problem investigation• Actions taken- to correct problem• Results – new data, tracking• Making it stick – sustainability plans,MAINTAININGhardwiring plans,

Problem• At baseline in 2008, only 27% of our patientswere within a safe and established range ofanticoagulation.• Clinical standards define the established saferange or “time to therapeutic goal” to bewithin 24 hours.

Goal Setting:• Based on an accepted measure and goal, weestablished a target of 80% of our patients toachieve therapeutic range within 24 hours ofheparin infusion administration.

Fact Finding – What are the RootCauses?• We did a root cause analysis and found thereal problems were:– Additional staff education was required(Prescribers, RNs, RPhs)– Lacking attention and oversight– No easy reference tools– Anticoagulant dosing guidelines needed– Inconsistent blood collection times– Weight based dosing not established

Actions Taken• Once we understood the true root causes of ourproblem, the following measures were taken:– Hired our Anticoagulation RN NP for program oversight– Established anticoagulation dosing guidelines; educated allclinical staff on these guidelines– Established consistent blood collection times– Created and administered a competency assessment tool forall practitioners (prescribers, pharmacists, nurses)– Created an easy reference tool

Results/Data/Outcomes:• We now track our implemented solutions and wefound that hospital-wide: 81%* of patients areachieving therapeutic goal within 24 hours of heparinadministration• Our largest population of patients on Heparintherapy on two designated units have achieved 100%safe anticoagulation levels within 24 hours.* 81% = Average data from 2012 (1 st – 3 rd quarter)

Results/Data/Outcomes:

Results/Data/Outcomes:

Making It Stick:• We know that sustaining this gain is the hardest part.Hard-wiring for change is always a challenge. Theway we are doing this is:– Program oversight is key– Continuing education is vital• Quarterly education• Annual proficiency for all clinical staff– Standardizing blood collection times– Optimization of EMR order sets• Automatic dosing calculator

Questions?