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Fairview’s Coumadin clinics help keep patients healthy and out of the hospital

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Mary Strassburg, left, visits often with Sharon Peterson, RN,
to ensure she is taking the correct dose of Coumadin.
May 29, 2013
Keeping Mary Strassburg on her "Goldilocks" dose of Coumadin (Warfarin) to control her atrial fibrillation is a challenge Sharon Peterson embraces. Sharon is a registered nurse at Fairview Clinics – New Brighton.

Taking too little Coumadin—an antithrombotic medication—can lead to blood clots and strokes. Taking too much can lead to bleeding. Getting it just right requires a delicate balance that can change based on factors such as diet and other medications a patient is taking.

“Coumadin is a very helpful and effective drug, but it can be dangerous if you don’t monitor the patient’s INR [international normalized ratio] and other health factors closely," says Sharon.

"The INR tells us the amount of time it takes for the patient’s blood to clot and allows us to adjust the dose appropriately,” she adds. “Spending quality time educating patients on symptoms to watch for and what to do in specific situations they may encounter also is really important.”

Keeping her out of the hospital
A retired third-grade teacher, Mary was looking forward to relaxing and enjoying her children and grandchildren when life changed.

An episode of atrial fibrillation—an irregular and often rapid heart rate that commonly causes poor blood flow—along with a heart-related infection and bronchitis, landed her at University of Minnesota Medical Center, Fairview for six days in April 2007. That’s when she began taking Coumadin.

Following a week of rehabilitation and three weeks of home health care, Mary started visiting Sharon at Fairview Clinic – New Brighton to help her keep her Coumadin dosage at the right level.

“Sharon is one of the reasons I’ve only been in the hospital once since 2009,” says Mary, who has a history of hospitalizations due to atrial fibrillation, bronchitis and pneumonia.

“Before then, there were some years that I had 25 days in the hospital,” Mary adds. “She keeps a very close watch on me. She’ll say, 'I don’t like that cough' or 'We need to check this.' She is just much more proactive because I’ve got this history. So, my health is better overall.”

We’re significantly above average
Mary is among nearly 6,000 Fairview Clinics patients who visit with specially trained Fairview Clinics nurses or Fairview pharmacists every two to four weeks to ensure they’re taking the right dose of Coumadin. This approach is used primarily with patients who have atrial fibrillation, blood clots and mechanical heart valves.

These “clinics-within-clinics”—also called “Coumadin clinics,”“INR clinics” and “anticoagulation clinics”—are available in all Fairview primary care clinics. They have helped Fairview get 80 to 90 percent of these patients in range on their INR measure.

“Nationally, the number of patients taking Coumadin who are in range for their INR measure is about 50 to 65 percent,” says Mike Frakes, a Fairview pharmaceutical care specialist who started Fairview’s INR program in 2004 and continues to lead it in partnership with Leanne Roggemann, Fairview Medical Group director of nursing.

“The national guideline is 70 percent,” Mike adds. “Fairview is significantly higher because of our extensive training and ongoing support for clinic RNs, our patient education program and frequent patient check-ins with their clinic RN or Fairview pharmacist.

“What’s more, we do fewer INR tests per month per patient than the national average because we keep patients in range more consistently.”

Recently, our Coumadin clinics were named an Anticoagulation Center of Excellence by the Anticoagulation Forum, a nonprofit that works to improve the quality of care for patients taking antithrombotic medications by setting comprehensive standards that define ideal practices for anticoagulation services.

“Fairview’s practices meet and go beyond the guidelines for the Anticoagulation Center of Excellence,” says Mike. “We have achieved results no one thought were possible just a few years ago. Patients, nurses and doctors really love this service. It keeps our patients healthier and reduces hospital readmissions.”

Relationships become partnerships
Patients visit their Coumadin clinic every two to four weeks.

These frequent visits help patients build strong partnerships with their nurses or pharmacists. It also gives nurses greater insight into a patient’s needs—sometimes preventing other health issues from spiraling and leading to hospitalization.

“It’s more than just the INR that I’m looking at to help keep Mary healthy,” says Sharon. “I use the assessment skills I’ve developed over the years to see what is happening with her overall.”

“When Mary gets a cold, she needs intervention to ensure it doesn’t progress to bronchitis or pneumonia,” she adds. “I’m able to listen to her cough and get her in to see her primary care provider Carla Schwartz for a quick check while Mary’s in the clinic. Being proactive makes all the difference in her case.”

And Mary agrees.

“On Christmas Eve 2012, I came for my INR check, and I was coughing. Sharon asked me to see Dr. Schwartz and then I went to the medical center. I was there Christmas Eve to Christmas Day. They put me on IVs and medication, and I got better, so I was only there for one day,” says Mary.

“Had I not visited Sharon and Dr. Schwartz, I would have just kept on going because of the holidays,” adds Mary. “I would have gotten much sicker. Sharon is definitely my guardian angel. She knows my health history—and that I don’t want to be sitting home. I want to be active.”

The 'whole me'
“Sharon treats me like I’m not just another patient,” says Mary. “She’s concerned about the whole me…and I have the feeling she wants me to be as healthy as I can and to be able to do as much as I can.

“I stayed at this clinic when I changed insurance because of Sharon. I could have gone to another clinic but I said, 'No, I’ll pay higher co-pays to stay with Fairview because, as long as Sharon is here, I know that I will have better health. She is awesome."
 
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