MetroHealth Medical Center Outpatient Treatment of Venous

1
MetroHealth Medical Center Outpatient Treatment
of Venous Thromboembolism with
Low-Molecular-Weight Heparin Catalyst Initiative
Improvement Project

• Improvement Cycles Required
• Development of a Patient Education Program
• Development of a standardized follow-up system in
  the outpatient setting
• Involvement of multiple health care disciplines
• Resolution of cost issues

• Conclusions / Results
• Patients admitted to MHMC with VTE can be safely
  and effectively treated as outpatients with LMWH
  after a short hospital stay
• Pre-Protocol Protocol
• Total patients 60 59
• Related re-admits 4
  3
• Avg. Length of Stay 5.8 days 2.8 days
  
• Average days on protocol 8 days

• Aim of Project
• To provide safe outpatient management of patients
  with Venous Thromboembolism (VTE), including
  Deep Vein Thrombosis (DVT) and/or stable
  Pulmonary Embolism (PE), through the use of
  enoxaparin, a low-molecular-weight heparin (LMWH)
  which can be given by subcutaneous injection at
  home.

• Background
• Conventional treatment consisted of
• IV Heparin to prevent further clots
• Frequent blood draws during hospital stay
• LOS 5-7 days
• Proposed treatment consisted of
• Injections given once or twice per day instead of
  IV Heparin
• Blood draws once a day at home or clinic
• Less time in hospital (LOS 1-2 days)

• How did we overcome the Barriers?
• Team developed pre-printed orders which included
• Inclusion, exclusion criteria
• Weight-based LMWH dosing
• Initial oral blood thinner dosing
• Patient education materials
• Discharge Planning Orders
• Monitoring log
• Information on Indigent Medication Assistance
  Program
• Nursing and Physician Staffs were educated about
  the new protocol

• Team Members
• Marigel Constantiner (Team Leader)
• Matt Eisen (Facilitator)
• Sandie Amin (Facilitator)
• Robert Bahler
• Manoharan Balakrishnan
• Teresa Drocton
• Gaby El-Khoury
• Linda Horvath
• Cheryl Horvitz
• Marcia Kucler
• Kathy Lehman
• Thomas Lukens
• Margie Mazur
• Greg Palmer
• Lynette Seebohm

CATALYST INITIATIVE Quality Resource Unit

• Barriers
• Increased drug cost ( 300 for a 7 day supply)
• Lack of insurance for drug coverage
• Uninsured and underinsured patients
• Lack of reimbursement for Home Care
• Lack of routine retail pharmacy stocking