Apr 9 2014

Improving safety for patients on warfarin therapy

Orthopaedic Surgery/Anticoagulation Service partnership helps meet National Patient Safety Goals for high-risk medication

A partnership between the Department of Orthopaedic Surgery and the Anticoagulation Service improves patient safety for orthopaedic patients who are on high-risk/high-alert Warfarin therapy.

Brian Kurtz, PharmD, and Shelley Howells, LPN, from Anticoagulation Services, discuss a patient referral.

Post-operative Orthopaedic Surgery joint reconstruction patients typically receive anti-clotting medications such as Warfarin (Coumadin) to prevent deep vein thrombosis (DVT)—blood clots in the calf or thigh. This is a life-saving but high-risk/high-alert medication because staff must closely monitor the therapeutic levels in the blood.

In fact, the Joint Commission has made reducing the likelihood of patient harm associated with anti-clotting medications a National Patient Safety Goal.

Back in 2012, U-M faculty, staff — and most importantly patients — were dissatisfied with the level of management this high-risk population received. So, in January 2013, a multidisciplinary team formed to tackle the issue – as one of the inaugural “Lean – Train the Trainer” Projects under the Michigan Quality Initiative.

Using several lean tools, the team identified tasks within their control that they could change to improve the process to identify and monitor patients—and to get them started in the service.

“After several meetings, we aligned clerical work with clerical staff and significantly reduced the involvement of the clinic/phone triage nurses and Joint Service mid-level providers associated with managing these patients,” says Dorothy Nalepa, administrative manager of the Taubman Center Orthopaedic Surgery Clinic. Read the rest of this entry »