A Project ECHO® Series
Anticoagulants in Long-Term Care
Series Resource Page
Data reveals the number one adverse drug event (ADE) leading to hospitalizations and emergency department (ED) visits in nursing homes is related to anticoagulant/blood thinner medications. This resource contains the recordings and supplemental materials for the Anticoagulant ECHO® Series. The objective of this series is to improve patient outcomes by learning from subject matter experts that share key information and strategies focusing on the management of blood thinners, resident safety and quality of care.
Review each session’s brief summary to prioritize and select which to bring to facility leadership and Quality Assessment and Performance Improvement (QAPI) meetings. Take action today:
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- Watch the session recording
- Use tools and resources
- Implement the call to action under each session title
Long-Term Care Medication Management of Blood Thinners
Audience: Long-term care administrators and other leaders, Directors of Nursing, nurses, Certified Medication Aides (CMAs), Certified Nursing Assistants (CNAs) and all staff involved in the medication management process who are eager to improve resident safety by decreasing adverse drug events from anticoagulants (blood thinners).
Click to expand and view session details.
Session 1: Introduction to Adverse Drug Events Related to Anticoagulants
During this session, adverse drug events are defined and Dr. Gregory Gahm, MD, Chief Medical Officer of Vivage-Beecan of Colorado, discusses the value of anticoagulant medication monitoring and recognizes opportunities for process improvement.
Download the Presentation Slides
Resources:
- The Age-Friendly Health System (AFHS) provides a framework of evidenced based practices to align with what matters to the older adult through the 4Ms: What Matters, Medication. Mentation and Mobility.
- 2018 All Cause Harm Prevention in Nursing Homes Change Package review the ‘Prevent excessive bleeding due to medication (antithrombotic)’ section starting on page 13.
Call to Action:
- Use this QAA/QAPI Meeting Agenda to bring the high-risk medication management program to Quality Assessment and Assurance (QAA) meetings.
- Incorporate quality improvement activities relating to the management of blood thinners by using Telligen’s Quality Improvement Workbook.
Session 2: Anticoagulant Adverse Drug Event Recognition and Safety Review Tool
During this session, participants are encouraged to evaluate their current and potential anticoagulant safety processes. Telligen’s new Anticoagulant Safety Review Tool is demonstrated so staff can learn how to utilize this at their facility.
Download the Presentation Slides
Resource: Telligen’s Anticoagulant Safety Review Tool – Utilize this tool to review and establish processes to monitor residents treated with anticoagulant medication for potential adverse drug events (ADEs).
Call to Action: Have a team discussion about the current state of anticoagulant use and practices at the organization. Use the resource tool to identify and assess for care planning needs of residents.
Session 3: Communication with Residents and Representatives
Learn from RoseAnna Milanovic, Senior Quality Improvement Facilitator with Telligen, as she explains the importance of health equity and literacy for improved communication, informed consent and effective communication strategies. Hear from Mary Schramke, Telligen Beneficiary and Family Advisory Council (BFAC) member and Patient and Family Engagement (PFE) advisor, about her story of a loved one who was affected by the adverse consequences of blood thinners and her ideas for improving communication with residents and their representatives.
Download the Presentation Slides
Resources:
- The Agency for Healthcare Research and Quality (AHRQ) created this Implementation Guide for AHRQ’s Making Informed Consent and Informed Choice Training Modules for supporting informed consent and informed choice. Contents include training modules, how to get started, implementation, identifying staff that will lead the initiative, and a survey to assess informed consent is included in English and Spanish.
- Access this AHRQ SHARE Approach Fact Sheet. The Seek, Help, Assess, Reach, Evaluate (SHARE) Approach is a five-step process for shared decision making that includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to residents.
- Visit Telligen’s health equity webpage and demonstrate your commitment to making health equity a priority in your organization or community by exploring the resources.
Call to Action: Create a process for communication best practices within the organization to strengthen open communication between staff and resident-family representatives.
Session 4: Communication with Prescribers, Pharmacists and Others Outside the Facility
During this session, the importance of collaboration with prescribers and pharmacists is discussed. Our panelist of experts including Dr. Gregory Gahm, MD; Dr. Keith Swanson, PharmD; and Dr. Bryan Whyms, DO, identify key information necessary to ensure positive resident outcomes when communicating and options for implementing best practices when collaborating across the care continuum.
Download the Presentation Slides
Resources:
- This Stop and Watch Early Warning Tool can be used by anyone on the team and resident representatives to communicate early symptoms of change in condition.
- 2018 All Cause Harm Prevention in Nursing Homes Change Package review the foundational components in appendix B to develop an infrastructure that promotes teamwork and communication.
Call to Action: Educate yourself, the resident and/or representative, and team members on anticoagulants, their uses, side effects and potential adverse effects. Evaluate your communication techniques with prescribers, the pharmacy, lab, the resident and/or their representative. Collaborate bring all the parties to the table to determine the best course of action for the resident.
Anticoagulant Use in Long-Term Care – What Prescribers and Pharmacists Should Know About Anticoagulant Best Practices
Audience: Prescribing Clinicians, Medical Directors, Consulting Pharmacists
Click to expand and view session details.
Session 1: Introduction to Anticoagulant Adverse Drug Events and the Impact on Long-term Care
During this session, Telligen’s Dr. Denton Chancey, PharmD, MBA, compares the incident rates of adverse drug events (ADEs) in the Medicare fee-for service (FFS) population, describes the financial and human impact of anticoagulant ADEs relating to long-term care as well as estimates the situation risk on relevant variables.
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Call to Action: It is encouraged that prescribing clinicians and pharmacists collaborate with long-term care providers to address the impact of anticoagulants on the health of the Medicare beneficiaries they serve.
Session 2: Warfarin Prescribing Practices
Dr. David Shepherd, DO, MBA, MS, CMD, an Internal Medicine physician and a multi-facility Medical Director, discusses the relative efficacy and safety profiles of apixaban and dabigatran compared to warfarin as well as identifies the indications for which warfarin is the most appropriate therapy.
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Call to Action: Gain understanding for the appropriate use of warfarin and reevaluate all patients currently receiving warfarin therapy to ensure they are on the safest medication for their diagnosis.
Session 3: Uses for Direct Oral Anticoagulants (DOACs)
Dr. Keith Swanson, PharmD, an Associate Professor of Pharmacy Practice, provides a summary of anticoagulation recommendations, shares data regarding combination of anticoagulant therapy risks and addresses decision points for patients in advanced age and increased frailty.
Download the Presentation Slides
Resource: ORBIT Bleeding Risk Score for Atrial Fibrillation (mdcalc.com)
Call to Action: Review and act on the recommendations for DOACs. Collaborate with long-term care providers to enhance the medication plan of care.
Learn more and access resources about high-risk medication management in long-term care by visiting Telligen’s High-Risk Medication ECHO® Series resource page.
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nursing homes
clinicians
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