Leveraging PowerChart for Improving Patient Safety with Anticoagulation Therapy

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Leveraging PowerChart for Improving Patient
Safety with Anticoagulation Therapy

• John Farringer, Pharm.D.
• University of Alabama Hospitals

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Goals and Objectives

• To discuss the functionalities utilized in
  PowerChart to provide safeguards for patients
  receiving anticoagulation therapy.
• Topics to be reviewed include
• Ordering
• Special OEF
• PowerPlans
• Decision Support
• Warfarin-INR rule
• Anticoagulation with Spinal Cord procedures
• HIT antibody alert
• Drug Interaction Checking (PT Committee
  Category 1)
• Monitoring Anticoagulation I-View

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Special OEF for Warfarin Orders

• Required entry of INR Max and INR Min
• INR target range contained in order detail line
• INR target range available to all users
• Nurses document latest INR as CDC when removing
  dose from Pyxis

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Warfarin Initiation PowerPlan

• Developed based on PT Committee Guidelines for
  Use
• Provides necessary orders for
• Laboratory tests
• Food and Nutrition consult
• Nurse Education
• Medication
• Falls Precaution

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Warfarin Initiation PowerPlan
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(No Transcript)
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Special OEF Required Order Details
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INR Range Contained in Order Details
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Food and Nutrition Notification for Consult

• Ad Hoc Report for all patients with warfarin
  orders
• MPTL for actual consults

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Heparin Protocol PowerPlans

• Weight Based
• Options
• 80 unit/kg bolus, 18 units/kg/hr infusion
• 60 unit/kg bolus, 12 units/kg/hr infusion
• No bolus, 12 units/kg/hr infusion
• Laboratory orders

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Order Catalog for Heparin Protocols
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Heparin 80/18 PowerPlan
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Heparin 80/18 PowerPlan (cont.)
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Orders Resulting from Heparin PowerPlan
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Heparin Protocol Built in Order Details
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Heparin Bolus Order Details
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Heparin Bolus Order Detail (cont.)
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Warfarin-INR Rule

• Alerts prescriber for actions outside PT
  Committee Guidelines for Use
• Alerts
• Order for warfarin with no INR w/in 7 days
• Order for warfarin with INR result gt patient
  specific INR Max (plus 2 for argatroban)
• Order for warfarin with INR lt patient specific
  INR Min (minus 0.2) AND no Bridge Therapy

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Alert for no INR w/in 7 days
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Order for Warfarin and Baseline PT/INR
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Order Warfarin -INR Above Range
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Alert INR gt Ordered Range
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Order Warfarin INR Below Rangeand no Bridge
Therapy
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Alert INR lt Range, no Bridge Therapy
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Parenteral Anticoagulation and Spinal Cord
Procedures

• Alerts for the potential patient safety issues
  when anticoagulation is used within 7 days of
  procedures involving the spinal cord
• Evoked by anticoagulation order when spinal cord
  procedure has already been documented
• Evoked by order for spinal cord procedure if
  anticoagulation order has been in place

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Order for CSF AFB CulturePatient on Heparin
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Alert CSF Order on Heparin
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Order for EnoxaparinPatient on Fentanyl Epidural
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Order for EnoxaparinPatient on Fentanyl Epidural
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Alert Enoxaparin Order on Epidural
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Heparin Antibody Alert
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Heparin - Enoxaparin Interaction
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Warfarin - Amiodarone
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Drug Interaction AlertsData from January 2009
Drug 1 Drug 2 Total of Total of Class
Warfarin Various 1136 47  
Warfarin amiodarone 572 23 50
Warfarin levothyroxine 384 16 34
Warfarin sulfa-trimeth 83 3 7
Warfarin fluconazole 57 2 5
Warfarin erythromycin 33 1 3
Warfarin clarithromycin 3 0 0
Warfarin voriconazole 2 0 0
Warfarin cimetidine 2 0 0
Potassium Sparing Diuretic Various 827 34  
Potassium Sparing Diuretic Potassium 487 20 59
Potassium Sparing Diuretic ACE Inhibitors 283 12 34
Potassium Sparing Diuretic Angiotensin II blockers 57 2 7
Heparin Enoxaparin 354 15  
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I-View showing Heparin and Warfarin
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I-View showing Warfarin and Heparin
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That's All Folks !
QUESTIONS ???