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-ProtocolProtocol • 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