Sharing of Best Practices: Leveraging DAWN AC and a unique staffing - PowerPoint PPT Presentation

Sharing of Best Practices: Leveraging DAWN AC and a unique staffing model for a successful practice Kaiser Permanente Washington Region Paul Kuo, PharmD Manager, Anticoagulation and Anemia Management Service

Our Mission Kaiser Permanente exists to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Our Vision We are trusted partners in total health, collaborating with people to help them thrive and creating communities that are among the healthiest in the nation.

Kaiser Permanente Washington Region Formerly Group Health Cooperative, founded in 1947 • Acquired by Kaiser Permanente in 2017 • Managed Care Organization offering HMO, PPO, and Medicare • Advantage Plans 680,000 Members • 25 Full-Service Outpatient Medical Centers • 15 Walk-in Clinics located inside partner retail pharmacy chain • 5 Urgent Care Locations • 3 Ambulatory Surgery Centers • Contracted Hospital Services • 24/7 Consulting Nurse Service • 3 | CONFIDENTIAL

Anticoagulation and Anemia Management Service (AMS) Overview Centralized telephonic management of Warfarin, LMWH, DOACs, Epoetin, and Iron Call triage, patient letters, faxes, PCR 7000 non-attendance outbound calls 3.0 FTE Warfarin patients Open patients in DAWN, Email/Epic MA 350 message triage, PST Program, 3.0 FTE processing referrals DOAC patients LPN 100 Low acuity, stable, in-range patients 4.7 FTE Anemia patients Moderate acuity patients, INRs RN between 1.0 and 6.0, DOAC 2000 9.0 FTE monitoring and education Procedure Plans High acuity patients: New starts, annually Midlevels peri-procedural management, 8.0 FTE (RPh & ARNP) DOAC initiation and monitoring, anemia management, refills 4 | CONFIDENTIAL

Anticoagulation and Anemia Management Service (AMS) Staff: 3 Patient Care Representatives (3.0 FTE) • 3 Medical Assistants (3.0 FTE) • 5 Licensed Practical Nurses (4.7 FTE) • 10 Registered Nurses (9.0 FTE) • 10 Midlevels: 1 ARNP (0.5 FTE) /9 Pharmacists (7.5 FTE) • 1 Administrative Assistant (1.0 FTE) • 32 Total Staff + 1 Manager • Clinic Hours: (After hours support by Consulting Nurse Services) Mon-Fri: 8:00am to 5:00pm • Sat: 8:00am to 4:00pm (1 LPN, 1 RN, 1 ML) • Sun: 3:00pm to 5:00pm (1 ML/work from home) • 5 | CONFIDENTIAL

Anticoagulation and Anemia Management Service (AMS) Clinic Organization: 25 Medical Centers divided into 3 Clinics • 3 Clinics (Green/Blue/Yellow) of over 2000 patients each • Each Clinic consists of: • 2 ML • 2 RN • 1 LPN • Additional flex staff assigned to cover specific duties as clinic • needs fluctuate (i.e. incoming calls, referrals, procedures, etc) Each clinic provides care for all needs (Warfarin, LMWH, DOAC, • Anemia) 6 | CONFIDENTIAL

DAWN AC Risk Classes Low • LPN Low with Drug Interactions • Medium • RN Medium with Drug Interactions • High • Bridge • Midlevels Enoxaparin Only • Enoxaparin Transition • Other Unclassified • 7 | CONFIDENTIAL

DAWN AC Letters Custom Messages Direct Print New Patient Packets Lab Orders and AMS treatment • • notes sent to Lab Information Travel Letter • System interface which interfaces Overdue Letter • into Epic Unable to Reach Letter • Faxed Orders and • In-Range Letter Communications sent through • RightFax interface Transition of Care • Insurance Termination • 8 | CONFIDENTIAL

DAWN AC Setup Other Features in Use Reminders Non-Attendance Used by MA’s to assign a new referral • • patient to the clinic for work up Procedures • Used by ML’s as clinic task list for Non- Groups: Used to track patients in our • • INR work and follow-up reminder Self-Testing Program system Drugs: Document Drug Interactions • Events: Track Adverse • (Bleeding/Thrombosis) Events Review: MA’s use to review • continuation of care after initial specified duration of therapy on referral – contacts physician for referral extensions Status: Patients suspended from • service due to non-compliance 9 | CONFIDENTIAL

Outcomes 10 | CONFIDENTIAL

What’s Next? DAWN AC Patient Self-Testing Module • Expanding use of DAWN Messaging for internal communications • Extending the maximum testing interval to 12 weeks • Monitoring adverse events from claims data • DOACs • 11 | CONFIDENTIAL

Discussion/Questions