Anticoagulation in ambulatory care: an evidence-based review of the literature.
PURPOSE OF THE MANUSCRIPT: Anticoagulation is warranted for the treatment of various disorders including cardiac, vascular, and postsurgical causes. Many centers have nurse case managers to coordinate care for patients on anticoagulation. This increases the demand for specific guidelines to assist nurse case managers to ensure quality of care. This review will address guidelines for nurse case managers and providers regarding initiating anticoagulation treatment and monitoring prothrombin time and international normalized ratio. Information will also be provided regarding when the nurse case manager should notify the providers to establish target international normalized ratio. This review will also provide educational tools to serve as standards for patient teaching, including drug and food interactions.


METHODS
This article applies to adult ambulatory practice that includes primary care, cardiology, and vascular and surgical settings.


CONCLUSIONS
The complexity of managing anticoagulation in ambulatory practice warrants case management. The nurse case manager will establish a rapport with patients to improve compliance, providing patient education about diet, dosages, and drug interactions to reduce medication errors and bleeding complications. This review on anticoagulation management will assist nurse case managers and providers to provide better quality of care.
Venkatachalam
Varalakshmi
V
Hartford Hospital in Hartford, CT 06106, USA.
D'Attilio
Karen
K
Lewis
Ann
A
Acevedo
Myrtha
M
D000553:Ambulatory Care / Q000458:organization & administration*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D019090:Case Management / Q000458:organization & administration*; D003266:Continuity of Patient Care; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009730:Nursing Assessment; D010349:Patient Compliance; D010351:Patient Discharge; D010353:Patient Education as Topic; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011517:Prothrombin Time; D011785:Quality Assurance, Health Care; D020246:Venous Thrombosis / Q000188:drug therapy
D000925:Anticoagulants