Harbor:Coumadin clinic

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Effective Monday, November 30, 2015 we will be able to directly book an appointment for our ED patients who need anticoagulation clinic follow-up, without having to first page/call the anticoagulation NP. This brings our practice for anticoagulation clinic more in alignment with our other practices for patients who need time-sensitive (< 2 weeks) follow-up after their ED visit, in that we try to have them leave with an appointment in hand. Please see attached updated disposition flowchart for ED patients. Protocol:

  • Document well within your note the indications for anticoagulation. If for VTE, please include historical features including provoked vs unprovoked, prior history of VTE, active malignancy, etc.
  • If the patient does not have a PMD, please refer to CCC for empanelment.
  • Ask the ED clerk to book the patient into anticoagulation clinic within 7 calendar days. Do this by completing the follow up section in the Orchid discharge process. The request for follow up should include the service (anticoagulation clinic), the timeframe (within 1 week), and the name of the MD who OK'd the overbook (Dr. French). A black star should appear on the trackboard. If there are no open slots, the clerks should automatically place the patient’s info into the “request queue” in ORCHID. The patient will then be contacted the next business day for overbook.
  • Prescribe for the patient at 7 days of anticoagulation therapy.

Note: hospital policy is that discharge prescriptions for anticoagulation therapy are limited to 7 days.

You may write for up to 30 days of warfarin for patients who are already stably anticoagulated and just need a refill if you indicate “refill for stably anticoagulated patient” on the prescription. An example would be the patient with atrial fibrillation and a high CHADS-VASc score who had been on Coumadin with stable INRs for years, but recently lost Kaiser insurance and needs refill and plug-in to anticoagulation clinic. Please also ask the ED clerk to book this patient into anticoagulation clinic, but could have a longer time frame, i.e. up to one month.

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