1. Systematic Anticoagulation Management in the Rural Health Setting
Lisa Vaughn RN, CACP
Clinical Manager Anticoagulation Services
Wenatchee Valley Medical Center

3. Wenatchee Valley Medical Center
Serving more than 160,000
unique patients annually….
….over 750,000 patient visits per year in an area that covers 12,000 square miles
300 Physicians, Physician Assistants,
and Nurse Practitioners….
85 Primary Care Physicians, PA’s, & ARNP’s
1500 Employees in eleven communities and four counties

4. Wenatchee Valley Medical Center

5. Our Mission
To provide our patients with the highest quality health care and service in a friendly and caring atmosphere
Committed to assisting in the development of one of the nation’s best rural health care delivery systems

6. Common Scope of Service
Face-to-face visits with APC
Patient Self Testing
Televideo appointments
Home visits
POC INR Testing
EMR Patient access for lab results, RX renewal, scheduling, health care questions
Patient Education – NOA
My Chart access to medical records, scheduling and health advice

7. DAWN AC - Organization
7 ACC locations with 8 full time and 4 part time advance practice providers
2100 patients
5 separate DAWN Organizations
Providers with DAWN clinics at multiple organizations
DAWN groups – Home Visits, Self Testing and APS

8. Collaboration to Provide Safe Care
Patient Tracking
Quality Measures
TTR
Elevated INRs
Time to Therapeutic
Clinical outcomes (Bleeding, TE, Fatalities)
Staff Proficiency and Competency
ACC specific practice plan for APCs
Standardized Lab Monitoring – POC INRs, POC-Lab Correlation Studies

9. Standardized System Wide:
Policies and Procedures
Patient education resources
Peri-op/procedure program
Documentation tools (Coded Comments)

10. Systematic Therapy Management
Evidence Based Protocols:
Warfarin Induction
Risk Assessment
Managing Non Therapeutic INRs
Follow-up Intervals
Peri-procedure/operative Management
Elevated INRs
Anticoagulation Related Labs
Management of Patients with APS

11. Systematic Scheduling
Transition of care inpatient-outpatient
New Patient Enrollment
Routine Follow
Management of No Shows
Management and Documentation of Non Compliance
Peri-procedure/operative visits

12. Teamwork Job descriptions/APC Practice Plan
Staff and provider training and CME
Performance Improvement Projects
CACP Certification
Bi weekly meetings
Standardized workflows
Weekend and holiday service

13. Throughout all locations
Advanced Practice Provider Practice Plans
Anticoag Clinic physician oversight
Administrative support
Staff and provider coverage for time off
Pharmacy support

14. Shared Resources

15. Shared Medical Record
DAWN AC – continuum of care between ACC locations
EMR with interfaces with DAWN AC

16. Interactive Medical Record
Cadence
EpiCare
DAWN AC

17. DAWN – Lab Interface Lab-all WVMC lab locations export INR to DAWN
Diminishes manual data entry errors
No delay in time from reporting to appearance in DAWN List View Worklist
Undosed INRs visible at all ACC locations
4 labs

18. DAWN – EMR ADT Interface
Demographic information
Appointment scheduling
Tracking and documenting non compliance in DAWN

19. Cadence Appointment → Dawn Dose Schedule

20. DAWN – Communication with Multiple Health Care Providers
Exporting DAWN Quick Note to EMR and link in EMR to DAWN
Immediate access to DAWN records:
Other WVMC healthcare providers
Outside healthcare providers: DAWN→EMR→Epicare Link
Peri-procedure/surgical anticoag management plan – Two hospitals

21. Shared in DAWN Treatment Plan Annual physician order updates - Reviews
Patient tracking – List Views
Quality Measures – Benchmarking and Reports
Patient Education – Letters
Groups- Home visits, APS, PST
Documentation – Coded Comments

22. Load Leveling

23. List Views
Filter by provider

24. Cross Coverage Telemedicine Visit Weekend Coverage
Peri-operative/procedure management
Unexpected INR results

25. Looking Forward Increase in patient population +
Multiple locations for care
Addition of new anticoagulants
Continued need for expertise and standardization and systematic process for administrative and clinical management

26. Reference
Delivery of Optimized Anticoagulant Therapy: Consensus Statement from the Anticoagulation Forum
David Garcia, Daniel M Witt, Elaine Hylek, Ann K Wittkowsky, Edith A Nutescu, Alan Jacobson, Stephan Moll, Geno J Merli, Mark Crowther, Laura Earl, Richard C Becker, Lynn Oertel, Amir Jaffer, and Jack Ansell
The Annals of Pharmacotherapy July/August, Volume 42

27. List View - Worklist

28. List View-Risk Class

29. List View-All Patients

30. List View – New Patients

31. List View – Annual Requirements