The 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.
• Acts in the same capacity and is held to the same standards of clinical and professional performance when performing job duties in the AMS clinic.
• 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.
• 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 complications
• 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
Applicants with relevant experience will be considered. Salem Hospital, a member of Mass General Brigham, is an affirmative action/equal opportunity employer. Minorities and women are strongly encouraged to apply. Pre-employment drug screening is required.
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Grow, learn and develop new practice innovations.
Continue your medical education.
Make academic connections and explore teaching opportunities.
Explore leadership opportunities.
Develop clinical and administrative career ladders.
A supportive practice environment
Patient-centered care model.
Leadership that listens and values your contributions and ideas.
Autonomy and respect for your skills and expertise.
Excellent salary and benefits.
NSPG’s MHQP Patient Experience surveys show that we perform higher than the state mean in all domains with 92% of patients indicating that they would recommend NSPG services.
Our physicians are polling in the top 75th percentile of AMGA Satisfaction metrics for almost every major category—the highest physician satisfaction scores of any medical group in the Boston region.
25th percentile in MGMA cost benchmarks and top 75th percentile in revenue benchmarks.
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