OverviewThe Anticoagulation Management Service (AMS) uses a primary nurse model to assess and intervene to best meet the educational needs of patients and families while striving to optimize day-to-day outcomes of anticoagulation management. Primary nurses partner with patients and families and multiple disciplines to manage long-term outpatient anticoagulation therapy while coordinating transitions of care across the continuum as needed.
Major components of the role include patient and family education, short and long-term management of anticoagulation consistent with both NSPG and AMS Policies and Procedures.
- Provides a plan for anticoagulation management for patients receiving induction, bridging, and maintenance therapies.
- Is accountable to the patient and family for the initial and ongoing assessment and development of a patient-specific plan of care.
- Educates patients during initial assessment and teaching session(s) and ongoing as needed.
- Informs patients how and when to communicate with the AMS staff.
- Collaborates with referring providers to assure that an anticoagulation plan of care appropriate to patient specific risk is established.
- Uses NSPG and AMS Policy and Procedure to optimize anticoagulation management.
- Schedules and receives INR results for warfarin patients at intervals appropriate to anticoagulation status from clinical laboratories, home care providers, and/or patients.
- Evaluates warfarin dose response based on INR results and relevant clinical and behavioral characteristics that influence patterns of absorption, distribution, metabolism, and elimination of warfarin.
- Determines warfarin dosing using established protocols.
- Monitors dosing and patient clinical response to therapeutic bridging medications and discontinues use per NSPG protocols.
- Monitors anticoagulant drug supply, reviews pertinent laboratory values to guide therapeutic decisions.
- Collaborates with referring providers on agent selection and initiation
- Provides transitions to and from warfarin and other oral anticoagulants
- Provides outpatient oversight for peri-procedural management of all anticoagulants
- Provides oversight and collaboration concerning population specific dosing related to renal dysfunction, drug interactions or extremes of body weight.
- Provides medication adherence monitoring and assessment.
- Carries and ensures appropriate sign in and function of pager during assigned call hours
- Is accountable to find coverage and communicate all changes in coverage whenever unable to complete some or all assigned on-call hours
- The on-call AMS RN promptly returns paged calls, collects results and/or pertinent information from callback contact, conducts assessment or the presenting problem, facilitates triage of patients as required and/or provides education, instruction as needed and performs other responsibilities consistent with scope of practice and documented policy and procedure.
- The AMS RN acts in the same capacity and is held to the same standards of clinical and professional performance while on-call as when performing job duties in the AMS clinic.
- The on-call AMS RN is not required to travel back to the clinic or hospital site in any situation during call hours and is compensated at the on-call rate for all on-call hours. Any consideration of the need to return to the hospital should be made in collaboration with the AMS Nurse Director.
- The AMS Nurse Director should be notified immediately of any high-risk event including but not limited to; significant patient injury related to their anticoagulation therapy resulting in hospitalization or death or any issue that may require reporting.
- The on-call AMS RN is responsible for ensuring the he/she has access to ALL electronic information systems required in the care of AMS patients and that all interactions are documented and followed up as necessary during business hours
- Communicates effectively
- Maintains documentation in the anticoagulation electronic record
- Uses electronic workflow management tools to monitor and manage work.
- Provides verbal and/or written communication of dose instruction to patients or providers as needed.
- Provides assessment and triage of information to and from patients and other providers including issues related to drug-drug interactions, life style, compliance, procedures and significant bleeding and clotting events.
- Seeks physician guidance in situations where care decisions and clinical concerns arise and follows up as needed.
- Provides oversight and appropriate follow up for all patients for such issues as missed appointments and non-compliance, critical results, contact of physician and other health care providers.
- Facilitates implementation of anticoagulation standards of care across clinical services
- Educates and supports providers to anticoagulation guidelines and protocols
- Participates in education of clinical staff; nursing grand rounds, patient care conferences, CEU offerings
- Participates as active members of the AMS Practice Committee and AMS Quality and Safety Committee
- Participates in data collection, evaluation of program outcomes, and the development of action plans to continuously improve clinical practice related to;
- Patient and staff satisfaction
- Quality metrics
- Nursing research questions
- The ability to make clinical decisions based on a strong knowledge base.
- A high level of interpersonal and communication skills.
- Basic computer skills
- Relevant anticoagulation experience
- Bachelor's Degree in Nursing
- Current licensure as a registered nurse in the Commonwealth of Massachusetts
- CACP certification
Applicants with relevant experience will be considered. North Shore Medical Center is an affirmative action/equal opportunity employer. Minorities and women are strongly encouraged to apply. Pre-employment drug screening is required.