SSMC's Anticoagulation Clinics

by Edward W. Nalband, M.D.

Our Anticoagulation Clinics in the Norwell and Kingston offices have a specially trained full time nurse and medical assistant. We believe this will allow our patients who are on anticoagulation therapy, specifically Warfarin/Coumadin to receive the best possible care. With approximately 400 patients currently on anticoagulation therapy we identified this as an important area for a dedicated program.

Much attention has been focused on medical errors in the press. A 1999 report of the Institute of Medicine concluded that 98,000 Americans die every year from preventable medical errors in hospitals. While not directly relating to our experience at the Medical Center we felt that all areas of patient care should be closely examined to identify those areas where there was more potential for oversight or medical error. Consequently anticoagulation therapy was identified as an important area to improve.

Our anticoagulation nurse, Donna Stransky, and medical assistant, Mary D'Eramo, are able to provide each individual patient with counseling regarding anticoagulation therapy, the importance of medical compliance, regular follow-up, dietary advice and warning signs for bleeding. All patients are tracked by computer to provide the close monitoring that patients on anticoagulation therapy require. This alerts the Anticoagulation Clinic and your Primary Care Physician when patients do not show up for scheduled follow-up visits. The Anticoagulation Clinic sends reminders to patients in order to assure compliance with physician recommendations. All orders from the Anticoagulation Clinic are reviewed by the patient's Primary Care Physician.

The Anticoagulation Clinic uses a finger stick methodology in order to obtain the Protime/INR. This allows the anticoagulation nurse to receive a result within a few minutes and apply an established protocol to decide what the recommended next dosing strategy will be for the patient, as well as the follow up PT/INR measurement. We believe this a significant improvement on our previous system of having the test result obtained through the laboratory and ultimately communicated to the patient by phone. This was usually characterized by a significant time delay, either from systems issues within the clinic, or inability to reach the patient by phone.

The Anticoagulation Clinic has identified a number of patients who where incorrectly taking their medication, not showing up for follow-up protime/INR measurements or had other clinical issues regarding their blood pressure or new clinical symptoms requiring medical attention. We feel it fulfills its mission of improving patient safety in as efficient a manner as possible. Indeed, we believe Anticoagulation Clinics will become the standard of care when administering anticoagulation therapy.

We are also available evening and Saturday hours.