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RN Managed anticoagulation programs

  • 1.  RN Managed anticoagulation programs

    Posted 05-09-2024 09:52

    Good morning,

    My organization is looking to benchmark with other organizations who have RN managed anticoagulation programs.  We are specifically looking for information on RN to patient ratios for these programs.  Thanks for considering!



    ------------------------------
    Elizabeth Carreira MSBA BSN RN NEA-BC CPPS AMB-BC
    Director of Nursing, Magnet Program Director
    Rochester Regional Health
    Rochester, NY
    elizabeth.carreira@rochesterregional.org
    ------------------------------


  • 2.  RE: RN Managed anticoagulation programs

    Posted 05-10-2024 09:52
    Edited by Amanda Rohrbaugh 05-10-2024 09:52

    Good Morning,

    I currently manage our Anticoag clinic. We are fully telemanaged and the nurse:patient ration is 350 to 1. I do believe that if you are providing POCT that the ratio is lower. 



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    Amanda Rohrbaugh BSN RN
    Clinical Manager
    WellSpan Health
    Marietta PA
    (717)799-1804
    ------------------------------



  • 3.  RE: RN Managed anticoagulation programs

    Posted 05-15-2024 14:04

    Would anyone who has an RN led AC clinic in place, please be willing to share the standing orders?  Our Rns only manage  compliance records and education  We do not mange dosing..  Thank you!  



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    Heidi Spielmaker RN
    Tapestry 360 Health
    Chicago IL
    (773)751-7850
    ------------------------------

    Original Message


  • 4.  RE: RN Managed anticoagulation programs

    Posted 06-17-2024 07:48

    Hi Heidi,

    The clinic I work at we do use a standing order for INR management It works really well here, and we just adjusted it to also include 2.5-3.5 range. I would be happy to email it to you if you would like to look at it.



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    Jennifer Pease RN
    RN Care Coordinator
    NOTCH
    Saint Albans VT
    (802)370-5749
    ------------------------------

    Original Message


  • 5.  RE: RN Managed anticoagulation programs

    Posted 06-10-2024 13:33

    Hi Amanda

    Would you be willing to share your protocol with me? We have a protocol but it is pretty complicated and I am having nurses question if following it is outside their scope of practice. Were you able to keep it pretty simple for staff? 

    Thank you

    Shannon



    ------------------------------
    Shannon Hilliard RN
    Director, Outpatient Facilities & Operational Innovation
    Mount Nittany Physician Grp
    shilliard@mountnittany.org
    Bellefonte PA
    (814)278-4865
    ------------------------------

    Original Message


  • 6.  RE: RN Managed anticoagulation programs

    Posted 06-10-2024 15:54

    Hello Elizabeth,

    We have a virtual Anticoagualtion Program that has RN/LPNs dose per a guideline and APPs that review and approve each dosing plan.  The nurses are very successful and rarely have to re-call a patient with dosing changes.  When our program was established we found that a ratio of 1 to 300 (and up to 500) was used in other programs. We use 1 to 300. 

    We have productivity measures that we developed internally.   

    Happy to discuss further if you want to reach out rgray@saintlukeskc.org 

    Becky



    ------------------------------
    Becky Gray RN BSN MBA NE-BC
    Director Clinical Practice Integration
    Saint Luke's Physician Group
    Peculiar MO
    (816)599-9482
    ------------------------------



  • 7.  RE: RN Managed anticoagulation programs

    Posted 10-11-2024 08:28

    good morning! iknow this is from may--are you still looking for additional standing order info or do you have what you need?



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    Carrie Lemke DNP RN NPD-S BC
    Advocate Aurora Health
    Denmark WI
    (920) 655-7795
    ------------------------------



  • 8.  RE: RN Managed anticoagulation programs

    Posted 10-12-2024 06:15

    I am an anticoagulation nurse, the only anticoagulation nurse, for my 8 primary care offices. Currently I manage around 250 patients. I have approximately 10% that test at home or with their facility and the rest come to one of the 4 clinics I go to. I provide POCT testing and dosing management based on protocols set by the providers of the practices. It is within my scope to adjust dosing outside of the protocols if the situation grants those changes. I also provide lovenox bridge schedules for surgeries for any of my patients. I believe I could handle a 300 to 325 patient population. 



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    Shannon Branham
    Cone Health
    Burlington NC
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  • 9.  RE: RN Managed anticoagulation programs

    Posted 10-14-2024 12:36
    My organization has a little different model for warfarin management.  The laboratory does the testing and nurses manage the result telephonically using a protocol.  There is a pharmacist back up if the patient is outside the protocol.
    Stephanie


    Stephanie G Witwer, Ph.D., RN, NEA-BC, FAAN
    Department of Nursing
    Emeritus Staff



    Original Message


  • 10.  RE: RN Managed anticoagulation programs

    Posted 10-15-2024 11:50
      |   view attached

    Hello, Shannon

     

    I attached a document from 2019 you may find helpful and supportive in your efforts to obtain metrics related to Anticoagulation Management. Other organizations likely supporting standard metrics would be, The Joint Commission and The American College of Cardiology. I am sure there is also a Vascular and/or Hematologic organization as well. Nurse-led Anticoagulation has long been using the metric of TTR (time in therapeutic range) and I'll bet you could find this as national benchmark. However, there are so many other, "RN specific" outcomes recognized from this Nurse-led practice. We are using our critical thinking, providing patient education and assessments, collaborating with a number of different clinicians on the patient's behalf. We used to keep track of how many "saves" we had. We described saves as instances that required immediate attention by provider: Active bleeding, symptomatic bleeding, potential propagation of thrombus, need to be evaluated based on presentation (weight loss, SOB, pain and so on).

     

    We'd love to help you apply the Donabedian Model: Structure, Process and Outcomes when you feel you have the above identified. So often, benchmarking begins within our own clinics.

     

    Feel free to reach out on the Nurse Sensitive Indicator (NSI) forum with your questions and you will likely find more answers and support in your pursuit.

     

    We are here for you!

     

    Deb

     

     

    Deborah L. Cantlin, MSN, RN, CHFN

    Nurse Educator-Professional Practice

    Department of Nursing Excellence

    Pronouns (She/Her)

    603 650 6746

     

     

     

     




    Attachment(s)

    pdf
    -2019-09-18-110254 (1).pdf   409 KB 1 version
    Original Message


  • 11.  RE: RN Managed anticoagulation programs

    Posted 10-14-2024 06:40

    @Deborah Cantlin would probably be a great resource for this post! If I am not mistaken, this would fall under NSI.



    ------------------------------
    Torie Bonnet MSN RN NE-BC NPD-BC
    Clinical Nurse Education Specialist
    UNC Health
    Raleigh NC

    torie.bonnet@unchealth.unc.edu
    ------------------------------



  • 12.  RE: RN Managed anticoagulation programs

    Posted 06-19-2025 16:46

    Hello! 

    For those of you with RN managed anticoag programs - are you managing warfarin AND DOACs - are you doing bridging? If you are managing BOTH - what is your staffing ratio? 

    I also am curious - what is your % of patients nurse managed vs provider managed? 


    Thanks



    ------------------------------
    Jennifer Greer
    OSF Medical Group and OSF Home Care
    Bloomington IL
    jennifer.m.greer@osfhealthcare.org
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