December 16, 2014—Enhancements for Warfarin Orders on Discharge
To ensure the safety of patients who will be starting warfarin anticoagulation therapy on discharge, Order Entry has been enhanced to identify such patients, and prompt ordering providers with clinical decision support for writing the prescription. The resulting workflow also prompts for a consult with the MGH Anticoagulation Management Service (AMS)when appropriate, and notifies the AMS of the discharge order by email.
In addition, instructions are added automatically to the Patient Discharge Medication List (PDML) for all patients with an order for warfarin at discharge.
Presentation: Discharge Warfarin Enhancements
Key features:
For all patients with warfarin ordered on discharge, the PDML includes the following in the warfarin instructions: "Take as directed until your next INR and then call your warfarin manager (or physician who is managing your warfarin) for further dosing instructions. Please also see the Post Hospital Patient Care Plan."
Ordering providers are prompted to write an AMS consult order when AMS is selected to the follow patient on discharge, if the patient has no record of the consult for the current visit.
Ordering providers are prompted with clinical decision support (CDS) when writing prescriptions for warfarin for patients to be followed by the MGH Anticoagulation Management Service (AMS) who are starting warfarin therapy on discharge. Some exclusions apply.
Warfarin discharge information is sent automatically to the AMS for patients followed by that service on discharge.
See also: