MetroHealth Medical Center Outpatient Treatment of Venous
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MetroHealth Medical Center Outpatient Treatment of Venous Thromboembolism with Low-Molecular-Weight Heparin Catalyst Initiative Improvement Project. Improvement Cycles Required Development of a Patient Education Program Development of a standardized follow-up system in the outpatient setting

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MetroHealth Medical Center Outpatient Treatment of Venous

Thromboembolism with Low-Molecular-Weight Heparin

Catalyst Initiative Improvement Project

  • Improvement Cycles Required

  • Development of a Patient Education Program

  • Development of a standardized follow-up system in the outpatient setting

  • Involvement of multiple health care disciplines

  • Resolution of cost issues

  • Conclusions / Results

  • Patients admitted to MHMC with VTE can be safely and effectively treated as outpatients with LMWH after a short hospital stay

  • Pre-ProtocolProtocol

  • Total patients 60 59

  • Related re-admits 4 3

  • Avg. Length of Stay 5.8 days 2.8 days

  • Average days on protocol = 8 days

  • Aim of Project

  • To provide safe outpatient management of patients with Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT) and/or stable Pulmonary Embolism (PE), through the use of enoxaparin, a low-molecular-weight heparin (LMWH) which can be given by subcutaneous injection at home.

  • Background

  • Conventional treatment consisted of:

    • IV Heparin to prevent further clots

    • Frequent blood draws during hospital stay

    • LOS 5-7 days

  • Proposed treatment consisted of:

    • Injections given once or twice per day instead of IV Heparin

    • Blood draws once a day at home or clinic

    • Less time in hospital (LOS 1-2 days)

  • How did we overcome the Barriers?

  • Team developed pre-printed orders which included:

    • Inclusion, exclusion criteria

    • Weight-based LMWH dosing

    • Initial oral blood thinner dosing

    • Patient education materials

    • Discharge Planning Orders

    • Monitoring log

    • Information on Indigent Medication Assistance Program

  • Nursing and Physician Staffs were educated about the new protocol

  • Team Members

  • Marigel Constantiner (Team Leader)

  • Matt Eisen (Facilitator)

  • Sandie Amin (Facilitator)

  • Robert Bahler

  • Manoharan Balakrishnan

  • Teresa Drocton

  • Gaby El-Khoury

  • Linda Horvath

  • Cheryl Horvitz

  • Marcia Kucler

  • Kathy Lehman

  • Thomas Lukens

  • Margie Mazur

  • Greg Palmer

  • Lynette Seebohm

CATALYST INITIATIVE

Quality Resource Unit

  • Barriers

  • Increased drug cost (~ $300 for a 7 day supply)

  • Lack of insurance for drug coverage

  • Uninsured and underinsured patients

  • Lack of reimbursement for Home Care

  • Lack of routine retail pharmacy stocking