SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Anticoagulation Safety Education Subcommittee Prepared by Donna Grochow

VTE Prevention and Anticoagulation Safety Education A PROPOSAL October 2010

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

2010

Anticoagulation Safety Education Subcommittee Proposal

Educational Proposal Proposal for VTE Prevention and Anticoagulation Safety Education This proposal is to identify the recommendations of the education subcommittee of the VTE Prevention and Anticoagulation Safety Committee.

Education Subcommittee Overview: Goals of the committee are to develop: Patient, family education Staff education MD education (Outcomes and deliverable should address therapeutic and prophylactic management) Outcomes/Deliverables: Implementation of an inpatient education program for patients and families Implementation and documentation of appropriate staff education Implementation and documentation of appropriate MD education Easy accessibility to educational materials/resources Timeline: Patient education plan: September 2010 Staff education plan: October 2010 Roll-out of education: o Patient Education: October 2010 o Initial Staff Education: November 2010 o Comprehensive Staff Education: January 2011

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Educational Plan: Patient Education: The information available for patient education was reviewed by the committee. A need for more educational material was identified. Updated patient educational materials were developed and/or purchased. The following patient educational materials have been developed: 1. Information about Blood Clots 2. Preventing and Treating Blood Clots with Enoxaparin or Dalteparin 3. Preventing and Treating Blood Clots with Heparin 4. Preventing and Treating Blood Clots with Fondaparinux 5. Preventing and Treating Blood Clots with Warfarin 6. Preventing and Treating Blood Clots with Exoxamarin plus Warfarin (or Dalteparin plus Warfarin) The following patient educational video is now available for viewing via “On-Demand” Television: 1. “Staying Active and Healthy with Blood Thinners” : This video is a 10 minute educational video available in English and Spanish to help educate patients about how to use anticoagulant drugs safely. The following flowchart identifies the plan for disseminating the patient education: Inpatient Education for Prevention and Treatment of VTE Prevention:

Treatment:

Risk Assessment and orders for prophylaxis by Physician

Per Pharmacy protocol Per MD protocols

Admission Education: All Patients

Admission Education: All Patients

1:1 by Nursing Patient Education Materials: Information about Blood Clots for patients on prophylaxis

1:1 by Nursing Patient Education Materials: AHRQ video for patients on treatment

Ongoing Inpatient Education 1:1 by Nursing

Inpatient Education 1:1 by Pharmacist for complicated medication interactions (consult required)

Inpatient Education 1:1 by Dietician if needed for additional food-drug interaction education (consult required)

Discharge Education: All patients 1:1 by Nursing Patient Education Materials: Information about Blood Clots

Discharge Education 1:1 by Nursing Patient Education Materials: Medication Specific Handouts Preventing and Treating Blood Clots with Heparin Preventing and Treating Blood Clots with Enoxaparin or Dalteparin Preventing and Treating Blood Clots with Warfarin (generally patients with atrial fibrillation, treatment dosing) Preventing and Treating Blood Clots with Enoxaparin plus Warfarin

Discharge Education Home Kit for Enoxaparin

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

RN Education (Continuing education units will be provided). The proposal for education of the RN staff is as follows: 1. Anticoagulation Safety and Patient Education Self-learning Module: (November 2010) Objectives: (Items in bold with be emphasized) A brief overview of the following: (Based on AACN Practice Alert and Educational Resources) a. Define VTE b. Identify VTE Risk Factors c. Identify signs and symptoms of clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). d. Describe processes in place to assess patients on admission for VTE risk e. Describe treatment strategies for at risk patients f. Describe risk factors related to anticoagulation therapy g. Describe the patient education process. h. Identify the tools that have been put in place to assist the nurse in providing safe patient care i. Identify safe medication practices for the administration of enteral medications 2. Computer Based Educational Module: (RN Annual Competency Module: January 2011) Stop the Clot®: What Every Healthcare Professional Should Know: This module is a self-paced online course on the risk, prevention, and treatment of Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) and blood clotting disorders. Objectives: 1. Identify signs and symptoms of clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE) 2. Identify patient-specific risk factors for DVTs/clotting 3. Provide appropriate education, treatment, and management to reduce the risk of clot recurrence and secondary complications Content of Module: 1. Basics of Clotting-Optional 2. Basics of Thrombophilia-Optional 3. Anticoagulant Medications-Mandatory 4. Prevention of Post-Thrombotic Syndrome and Pulmonary Hypertension-Optional 5. Prevention of DVT/PE Recurrence-Mandatory

Pharmacy and Dietary Education: The proposal for education of the pharmacy and dietary staff is as follows:

1.

Computer Based Educational Module-January 2011 Stop the Clot®: What Every Healthcare Professional Should Know: This module is a self-paced online course on the risk, prevention, and treatment of Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) and blood clotting disorders.

MD Education The proposal for MD education is as follows: 1. Computer Based Educational Module 2. Grand Rounds 3. Faculty Meetings

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Research Component 1. Participate in research study in collaboration with UC Irvine Nursing Program: a. The purpose of the study is to identify nurses’ knowledge, practices and perceived barriers to risk assessment and prevention of VTE. There are no direct benefits from participation in the study. However, this study may provide findings that will be used to develop a focused educational program that may directly benefit bedside nurses at UCI Medical Center and will help improve patient safety. i. Nurse Survey: Nurse Survey on Venous Thromboembolism Risk Assessment and Prevention ii. Administer prior to education rollout: 1. October 18, 2010- November 12 iii. Administer at completion of education: 1. Date to be determined

Related Documents: 1. AACN Practice Alert (See Attachment Below) 2. Patient Education Handouts (See Attachment Below) 3. Educational Module 4. Teaching Plan 5. Nurse Survey

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Information about Blood Clots Blood clots can form in the deep veins of the body. Most often, they form in the legs, arms or groin. Blood clots are serious. It is important to know how to prevent them and also to know the signs and get treated right away. This leaflet tells about ways to prevent and treat blood clots.

Causes of Blood Clots Blood clots, also called deep vein thrombosis (throm-BO-sis) or DVT, most often occur in people: who can’t move around well or are confined to a bed or a chair much of the time who have had recent surgery who had a recent injury, like a broken bone (hip or leg), or have had a bad bump or bruise who have had cancer or are being treated for it who are obese who have had a stroke or are paralyzed who have had a blood clot before or have a family member who has had a blood clot who have taken a long trip (more than an hour) in a car, airplane, bus or train

A blood clot may have gone to your lungs if you suddenly have: a hard time breathing chest pain a fast heartbeat fainting spells

If this happens, your life could be in danger. Go to the nearest emergency room or call 9-1-1. Preventing Blood Clots You can help prevent blood clots if you: wear loose-fitting clothes, socks, or stockings raise your legs 6 inches above your heart from time to time wear special stocking, called compression stockings, if your doctor prescribes them do the exercises your doctor gives you change your position often, especially during a long trip eat less salt try not to bump or hurt your legs or cross them do not use pillows under your knees take all medicines the doctor prescribes you

Symptoms of a Blood Clot You may have a blood clot if you see or feel: new swelling in your arm or leg skin redness soreness or pain in your arm or leg a warm spot on your leg

If you think you have a blood clot, call your doctor* or go to the emergency room right away! Blood Clots Can Be Dangerous Blood clots that form in the deep veins in your legs, arms and groin can break loose and move to other parts of your body, including your lungs. A blood clot in your lungs is called a pulmonary embolism (POOL-mo-nar-ee EM-bo-liz-em). *In this leaflet, the term “doctor” can mean doctor, nurse,

Blood Thinner Medicines If you have been told you have a blood clot, your doctor may give you a type of medicine called an anticoagulant (an-te-ko-AG-you-lent). Your doctor will tell you how to follow this treatment. It may include shots and/or pills to be swallowed by mouth.

Side Effects of Blood thinners Bleeding is the most common side effect. Your doctor will watch you closely. If you notice something wrong that you think may be caused by the blood thinner medicine, call your doctor. If you think you are bleeding too much, call your doctor or go to the nearest emergency room. Tell them you are being treated for blood clots and the names of the medicines you are taking.

pharmacist, or other health care provider. 7

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Preventing and Treating Blood Clots with Enoxaparin or Dalteparin What is an Anticoagulant? A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid, like a clot or plug. Anticoagulants help to prevent new blood clots from forming and help to keep existing blood clots from getting worse. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. Anticoagulants come in many types, either given by a shot or a pill taken by mouth. Using aspirin, anti-inflammatory medicines such as ibuprofen or Motrin, platelet inhibitors, or other anticoagulants together may increase your risk for bleeding. Be sure to tell all of your doctors and dentists about all of the medications you are taking, including those your take without a prescription, vitamins or nutritional supplements, and herbal medications. Your doctors* will obtain blood tests that measure your blood levels and check for signs of hidden bleeding or other conditions while you are on an anticoagulant drug. Enoxaparin (Lovenox®) or Dalteparin (Fragmin®) You may be using either Enoxaparin (ee-noks-a-PARE-in) or Dalteparin (dal-tePARE-in). It is a blood thinner that is injected under the skin. It will treat blood clots in the lungs, legs, or other parts of the body. It will also prevent blood clots from forming in the blood vessels for patients with unstable angina or heart attack. Your doctor will decide what dose is best for you. Most patients only use it for a short time after a surgical procedure or while your warfarin (Coumadin ) starts to work. Your doctor will tell you when to stop the shots (injections). Your nurse will teach you how to inject this medicine. Please note that each syringe is used one time only. You will be told how to dispose of the used syringes. Please be sure to keep all your scheduled appointments after you are discharge to home. Call 9-1-1 if you experience any of the following: bleeding that does not stop severe pain difficulty breathing rash any other serious condition 8

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Please be sure to read all the information that you have been given. If you do not understand any of the material or would like more information, please ask your doctor. *In this leaflet, the term “doctor” can mean doctor, nurse, pharmacist, or other health care provider.

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Preventing and Treating Blood Clots with Heparin What is an Anticoagulant? A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid, like a clot or plug. Anticoagulants help to prevent new blood clots from forming and help to keep existing blood clots from getting worse. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. Anticoagulants come in many types, either given by a shot or a pill taken by mouth. Using aspirin, anti-inflammatory medicines such as ibuprofen or Motrin, platelet inhibitors, or other anticoagulants together may increase your risk for bleeding. Be sure to tell all of your doctors and dentists about all of the medications you are taking, including those your take without a prescription, vitamins or nutritional supplements, and herbal medications. Your doctors* will obtain blood tests that measure your blood levels and check for signs of hidden bleeding or other conditions while you are on an anticoagulant drug. Heparin This medicine is a blood thinner (anticoagulant) that is injected under the skin or given through a vein while you are in the hospital. Heparin (HEP-a-rin) will prevent blood clots from forming in people who have certain medical conditions or who are undergoing certain medical procedures that increase the chance that clots will form. It will also stop the growth of clots that have already formed in the blood vessels. It is not used to dissolve the clots that have already formed. The blood test that will tell your doctor how much heparin you need is called the activated Partial Thromboplastin Time or PTT. It tells your doctor how long it takes for your blood to clot. Heparin is usually given only when you are in the hospital. If you are instructed to use heparin shots when you leave the hospital, you will be told how to inject the medicine, how much to use and at what times, and how to dispose of the syringes. You will be told when to stop the shots. Please keep all scheduled appointments with your doctors. Call 9-1-1 if you experience any of the following: bleeding that does not stop severe pain difficulty breathing rash 10

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

any other serious condition Please be sure to read all the information that you have been given. If you do not understand any of the material or would like more information, please ask your doctor. *In this leaflet, the term “doctor” can mean doctor, nurse, pharmacist, or other health care provider.

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Preventing and Treating Blood Clots with Fondaparinux What is an Anticoagulant? A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid, like a clot or plug. Anticoagulants help to prevent new blood clots from forming and help to keep existing blood clots from getting worse. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. Anticoagulants come in many types, either given by a shot or a pill taken by mouth. Using aspirin, anti-inflammatory medicines such as ibuprofen or Motrin, platelet inhibitors, or other anticoagulants together may increase your risk for bleeding. Be sure to tell all of your doctors and dentists about all of the medications you are taking, including those your take without a prescription, vitamins or nutritional supplements, and herbal medications. Your doctors* will obtain blood tests that measure your blood levels and check for signs of hidden bleeding or other conditions while you are on an anticoagulant drug. Fondaparinux (Arixtra®) Fondaparinux (fon-da-PARE-i-nuks) is a blood thinner (anticoagulant) that is injected under the skin. It will treat problems in the lungs, legs, and other parts of the body caused by blood clots. It also is used to prevent blood clots from forming after hip, knee, or stomach surgery. Your nurse will teach you how to inject this medicine. Please note that each syringe is used one time only. You will be told how to dispose of the used syringes. Your doctor will tell you when to stop the shots. Please keep all scheduled appointments with your doctors. Call 9-1-1 if you experience any of the following: bleeding that does not stop severe pain difficulty breathing rash any other serious condition Please be sure to read all the information that you have been given. If you do not understand any of the material or would like more information, please ask your doctor. *In this leaflet, the term “doctor” can mean doctor, nurse, pharmacist, or other health care provider. 12

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Preventing and Treating Blood Clots with Warfarin What is an Anticoagulant? A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid, like a clot or plug. Anticoagulants help to prevent new blood clots from forming and help to keep existing blood clots from getting worse. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. Anticoagulants come in many types, either given by a shot or a pill taken by mouth. Using aspirin, anti-inflammatory medicines such as ibuprofen or Motrin, platelet inhibitors, or other anticoagulants together may increase your risk for bleeding. Be sure to tell all of your doctors and dentists about all of the medications you are taking, including those your take without a prescription, vitamins or nutritional supplements, and herbal medications. Your doctors* will obtain blood tests that measure your blood levels and check for signs of hidden bleeding or other conditions while you are on an anticoagulant drug. Warfarin (Coumadin®) Warfarin (WAR-fare-in) is a blood thinner (anticoagulant) that comes as a tablet to be taken by mouth. It will help prevent new blood clots from forming and keep existing blood clots from getting bigger. Your warfarin dose is based on what you eat and drink, what other medications you take, and how you feel (your health). It takes a few days to a week to start working in your body. You will need to have your blood tested often if you are taking warfarin. The blood test helps your doctor decide how much medicine you need. The Prothrombin Time (PT) or the International Normalized Ratio (INR) blood test measures how fast your blood clots and lets the doctor know if your dose needs to be changed. Testing your blood helps your doctor keep you in a safe range. If there is too much warfarin in your body, you could bleed too much. If there is not enough, you could get a blood clot. Once your blood test is in your target range and your dose is reached, this test is done less often. Because your dose is based on the INR blood test, it is very important that you get your blood tested at regular frequent appointments. Your doctor will tell you how long you need to take warfarin. Always take your warfarin as directed, at the same time of the day, every day. Never skip a dose, and never take a double dose. If you miss a dose, take it as soon as you remember. If you don’t remember until the next day, call your doctor for instructions. 13

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Many medications interact with warfarin and affect how it works. Before starting, stopping, or changing any medications (including over-the-counter products, nutritional supplements, and herbal remedies) talk to your doctor. Eat a balanced, healthy diet. Vitamin K from your food can affect how well warfarin (Coumadin ) works for you. It is important to keep your vitamin K intake about the same from day to day. Leafy green vegetables, such as kale, parsley, spinach, turnip or collard greens, broccoli, brussel sprouts, and others, contain large amounts of vitamin K. If you eat these foods, please eat consistent portion sizes each week. Avoid drastic changes in your diet. Call your doctor if you are unable to eat for several days or if you have stomach problems, vomiting, or diarrhea that last more than one day. Your warfarin (Coumadin ) dose may need to be adjusted if you are ill. Call 9-1-1 if you experience any of the following: bleeding that does not stop severe pain difficulty breathing rash any other serious condition Please be sure to read all the information that you have been given. If you do not understand any of the material or would like more information, please ask your doctor.

*In this leaflet, the term “doctor” can mean doctor, nurse, pharmacist, or other health care provider.

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SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

Preventing and Treating Blood Clots with Enoxaparin plus Warfarin (or Dalteparin plus Warfarin) What is an Anticoagulant? A blood thinner is a kind of drug called an anticoagulant (an-te-ko-AG-u-lent). “Anti” means against and “coagulant” means to thicken into a gel or solid, like a clot or plug. Anticoagulants help to prevent new blood clots from forming and help to keep existing blood clots from getting worse. Blood clots can put you at risk for heart attack, stroke, and other serious medical problems. Anticoagulants come in many types, either given by a shot or a pill taken by mouth. Using aspirin, anti-inflammatory medicines such as ibuprofen or Motrin, platelet inhibitors, or other anticoagulants together may increase your risk for bleeding. Be sure to tell all of your doctors and dentists about all of the medications you are taking, including those your take without a prescription, vitamins or nutritional supplements, and herbal medications. Your doctors* will obtain blood tests that measure your blood levels and check for signs of hidden bleeding or other conditions while you are on an anticoagulant drug. Enoxaparin (Lovenox®) or Dalteparin (Fragmin®) You may be using either Enoxaparin (ee-noks-a-PARE-in) or Dalteparin (dal-tePARE-in). It is a blood thinner that is injected under the skin. It will treat blood clots in the lungs, legs, or other parts of the body. It will also prevent blood clots from forming in the blood vessels for patients with unstable angina or heart attack. Your doctor will decide what dose is best for you. Most patients only use it for a short time while your warfarin (Coumadin ) starts to work. Your doctor will tell you when to stop the shots (injections). Your nurse will teach you how to inject this medicine. Please note that each syringe is used one time only. You will be told how to dispose of the used syringes. Please keep all scheduled appointments. Warfarin (Coumadin®) Warfarin (WAR-fare-in) is a blood thinner (anticoagulant) that comes as a tablet to be taken by mouth. It will help prevent new blood clots from forming and keep existing blood clots from getting bigger. Your warfarin dose is based on what you eat and drink, what other medications you take, and how you feel (your health). It takes a few days to a week to start working in your body. 15

SE2EOi, VTE Prevention and Anticoagulation Safety Proposal.pdf

You will need to have your blood tested often if you are taking warfarin. The blood test helps your doctor decide how much medicine you need. The Prothrombin Time (PT) or the International Normalized Ratio (INR) blood test measures how fast your blood clots and lets the doctor know if your dose needs to be changed. Testing your blood helps your doctor keep you in a safe range. If there is too much warfarin in your body, you could bleed too much. If there is not enough warfarin in your body, you could get a blood clot. Once your blood test is in your target range and your dose is reached, this test is done less often. Because your dose is based on the INR blood test, it is very important that you get your blood tested at regular frequent appointments. Your doctor will tell you how long you need to take warfarin. Always take your warfarin as directed, at the same time of the day, every day. Never skip a dose, and never take a double dose. If you miss a dose, take it as soon as you remember. If you don’t remember until the next day, call your doctor for instructions. Many medications interact with warfarin and affect how it works. Before starting, stopping, or changing any medications (including over-the-counter products, nutritional supplements, and herbal remedies) talk to your doctor. Eat a balanced, healthy diet. Vitamin K from your food can affect how well warfarin (Coumadin ) works for you. It is important to keep your vitamin K intake about the same from day to day. Leafy green vegetables, such as kale, parsley, spinach, turnip or collard greens, broccoli, brussel sprouts, and others, contain large amounts of vitamin K. If you eat these foods, please eat consistent portion sizes each week. Avoid drastic changes in your diet. Call your doctor if you are unable to eat for several days or if you have stomach problems, vomiting, or diarrhea that last more than one day. Your warfarin (Coumadin ) dose may need to be adjusted if you are ill. Call 9-1-1 if you experience any of the following: bleeding that does not stop severe pain difficulty breathing rash any other serious condition Please be sure to read all the information that you have been given. If you do Dayask Year not understand any of the material or would like more information,Month please your doctor. *In this leaflet, the term “doctor” can mean doctor, nurse, pharmacist, or other health care 16