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Transition and Coordination of Care Anticoagulation Centers of Excellence


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Transition and Coordination of Care

Patient Referrals

 Anticoagulation Service Referral Form
One page sample referral form from Frederick Memorial Hospital, Maryland. Note: DOACs not listed as anticoagulation option in sample page
 Referral, Assessment & Monitoring
Policy and Procedure for anticoagulation monitoring from U of Wisconsin Hospital and outpatient clinics
 Renewal Letter for Referring MD
Sample referral letter to physicians for anticoagulation monitoring; from Southwest General Hospital Coumadin Clinic
 Warfarin Referral Form
Sample referral form when transitioning patient on new anticoagulant, from inpatient and discharging to outpatient setting

Peri-Procedural Management including Bridging

 A Call to Reduce Bridging; Evidence based discussion of treatment options; 12/2015
4 page article published in Circulation; Evidence based discussion supporting vast majority of patients receiving warfarin therapy should not receive bridging anticoagulation during periprocedural interruptions of therapy by: Adam J. Rose, MD, MSc; Arthur L. Allen, PharmD, CACP; Tracy Minichello, MD; December 2015
 AF Bridging Update and Proposal
A new bridge therapy guideline that recommends avoiding LMWH for all AF patients during warfarin interruption; Siegal D et al., Douketis et al., Berge E et al., O’Donnell MJ et al, Paciaroni M et al., Bath PM et al
 An App from IPRO for Management of Anticoagulation in the Peri-Procedural Period
Updated 2016 by the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, this app helps clinicians simultaneously evaluate procedure-related bleeding risk & underlying risk of thrombosis; Guides decisions on interruption of anticoagulation and "bridging"; Guidance for dosing & laboratory monitoring in peri-procedural period; Encourages clear communication between prescribing clinicians & those performing invasive procedures
 Anticoagulation bridging decision support
A granular example of a unique power point decision support tool for perioperative bridging which will be embedded into Epic at Dean and St Marys Hospital; includes risk stratification/assessment
 Anticoagulation Task Group Guidelines for Periprocedural Management of Anticoagulants
Includes risk stratification/assessment, warfarin/LMWH bridging, dabigatran, rivaroxaban, antiplatelets, reversal)
 Bridge Worksheet and Patient Calendar
Includes plan and patient instruction sheet
 Guide for Perioperative Mgt of Adults on Warfarin, San Francisco VA, May 2016    NEW
2 page guideline evaluating bridging decision on the basis of bleeding risk; recommendations for treatment w/relevant practice notes & references; developed by UCSF: Margaret Fang,MD & Ashley Thompson, PharmD; VASF Anticoag & Thrombosis Service: Lisa Tong,PharmD, Joyce Lin,PharmD, Tracy Minichiello,MD; ZSFGH: Christina S. Wang, PharmD; May 2016
 Guidelines for Peri-Procedural Mgmt of Adults Taking dabigatran, rivaroxaban, apixaban, edoxaban, 2015
Guide developed by the VA of California,with bridging recommendations based on bleeding vs. thromboembolic risk; Margaret Fang, MD, Steven Kayser, PharmD, Tracy Minichiello, MD, Christina S. Wang, PharmD
 How I treat anticoagulated patients undergoing elective procedure or surgery (Spyropoulos & Douketis, 2012)
Article from Blood outlining risk, strategy and management as it pertains to patients on anticoagulants
 How to Manage Patients Who Need a Procedure, April 2014
April 2014 Powerpoint by Dr. Robert D.McBane, Division of Cardiology, Mayo Clinic Rochester, how to approach anticoagulation (Warfarin & DOACs)given published bleeding & thromboembolic event rates
 Management of Anticoagulation Therapy - Presentation from Chest Guidelines
25 page PowerPoint 9th edition of CHEST guidelines, 2012
 Perioperative Bridging Anticoagulation Patients with Atrial Fibrillation; NEJM 8/2015    NEW
Link to the NEJM BRIDGE study, August 2015
 Perioperative Bridging Guidelines
Includes risk stratification/assessment,warfarin/LMWH bridging, dabigatran,rivaroxaban,antiplatelets) from OHSU, 2012
 Perioperative Guideline
Includes clinician responsibilities,risk stratification/assessment, warfarin/LMWH bridging,dabigatran,antiplatelets) Northern California Kaiser Permanente Outpatient Anticoagulation Clinic, 2012
 Perioperative Management of Antithrombotics
Includes risk stratification/assessment, warfarin/LMWH bridging, dabigatran, rivaroxaban, antiplatelets)
 Perioperative management of patients on new oral anticoagulants (Lai June 2014)
Article from British Journal of Surgery outlining anticoagulant interruption strategies for elective and emergency procedures, June 2014
 Periprocedural Guideline, UW Health 2015
Guideline containing strategies and recommendations designed to assist clinicians in developing periprocedural antithrombotic management plans; providing recommendations on how to identify patients who are in need of periprocedural bridging based on thrombosis and bleeding risks
 Progress Note for Peri-Procedure Anticoagulation Management
INTEGRIS, Baptist Medical Center Anticoagulation Clinic, word doc of progress notes
 UNM Protocol For Periprocedural Management of Antithrombotic Therapy, 8/2016    NEW
6 page protocol including risk assessment, decision tree, cessation and re-initiation outline for DOACs and Warfarin and bridging recommendations; includes information on dialysis patients and antiplatelet management; updated August 2016
 Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation, Circulation 2/2015    NEW
Article available on pubmed -- Prospective observational registry assessing use of peri-procedural bridging in AF patients; please also refer to accompanying editorialShaikh AY, McManus DD. A Bridge Too Far? Findings of Bridging Anticoagulation Use and Outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation. 2015 Feb 3
 UW Medicine Peri-Procedural Anticoagulation
Risk stratification/assessment, warfarin/LMWH bridging, patient instruction form, specifics for dental procedures)

Transition Between Agents

 Helpful "dot phrases" to implement for procedure plans in EPIC    NEW
background phrases to assist EPIC users
 Transitioning To & From the Novel Oral Anticoagulants: a Managemenet Strategy for Clinicians (Abo-Salem Feb 2014)
7 page Article from Journal of Thrombosis and Thrombolysis outlining risks during transitions between direct acting oral anticoagulants (DOACs) and different transition scenarios and strategies
 Transitions Among Anticoagulant Medications
5 page table from University of Utah Health Care Trombosis Service providing guidance when transitioning between agents; 4/2013; includes Warfarin, Parenteral Agents, Dabigatran, Rivaroxaban, & Apixaban in simple to easy charts

Transitions Between Patient Care Settings

 Delivery of Optimized Inpatient Anticoagulation Therapy: Consensus Statement from the Anticoagulation Forum, May 2013
From the AC Forum, guidelines designed to promote optimization of patient clinical outcomes while minimizing the risks for potential anticoagulation-related errors and adverse events. Table 8 in the article includes a “Care Transitions Checklist”
 Impact of direct oral anticoagulants on transitions of care and outpatient care models
Article by Ann K. Wittkowsky, PharmD, overviews the importance of appropriate transition of care management and provides examples of transition-of-care models and how anticoagulation clinics can and should maintain involvement with the DOACs.
 Project RED: How to Conduct a Post-Discharge Follow-up Phone Call
Project RED (Re-Engineered Discharge) is an AHRQ/NHLBI-sponsored initiative to improve the hospital discharge process. This document outlines the key components of the post-discharge follow-up call.
 Transitions of Care Between Healthcare Settings Webinar
53 minute webinar by Dr. Michael Wagner, CMO from Tufts Med Cntr, addresses components of effective transfers, increase in focus on transfers in care and how information technology can support transfer initiatives
 Transitions of care in anticoagulated patients (Michota 2013)    NEW
Article from the Journal of Multidisciplinary Healthcare that is outdated for drug therapy information but valuable for its sections on hospital discharge protocols and outlining barriers to safe and effective anticoagulation during care transitions
 Transitions of Care in Patients Receiving Oral Anticoagulants: General Principles, Procedures, and Impact of New Oral Anticoagulants
Link to article from the journal of Cardiovascular Nursing: Jan/Feb 2013; Informative article addressing clinical challenges, offering potential solutions surrounding anticoagulation therapy with warfarin during transitions of care. Article also discusses the new oral anticoagulants.
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