Anticoagulation Service For Health Professionals
Physician and Other Health Care Provider Responsibilities when Using LMWH During the Initiation of Warfarin
Physician |
Management |
HomeMed | Nursing | Service |
Pharmacy |
Pharmacy |
| Write order in chart for LMWH and for nurse to provide pt education | Instruct pt on injection techniques and provide educational materials on LMWH and warfarin. | Prepare LMWH for injection by nurse and patient during hospital stay | ||||
| Call Practice Management to discuss case and arrange f/u of pt post- D/C. | Evaluate anticipated status of pt post-D/C. Assess pt's insurance coverage of home care and LMWH. If necessary, contact HomeMed or preferred provider. | Confirm that UM Anticoagulation Service will follow pt post-D/C | If pt unable to self-administer LMWH, discuss VNA referral w/ pt's physician and Practice Management | Fill prescription for home supply of LMWH if pt has prescription coverage | ||
| Consult Anticoagulation Service | Continue to interact w/ pt's MD and nurse during balance of hospitalization. If needed, arrange VNA or other appropriate post-D/C care. | If pt not followed by UM AC Service, contact pt's local physician to coordinate INR f/u and warfarin dose-adjustment | Provide warfarin and LMWH education | |||
| Write Rx for outpatient supply of LMWH (7 days, w/ one renewal). | Inform UM AC nurses of who will be distributor of LMWH (can do via AC Service alpha-pager--# 7248) | Prepare syringes and coordinate discharge planning with Practice Management | If pt not candidate for f/u by AC Service, contact referring physician and Practice Management so alternate plans for INR monitoring can be made. | |||
| If appropriate, route Rx for home supply of LMWH to UM Outpatient Pharmacy. | Call AC Service 4-6 days post-D/C to determine if LMWH Rx needs renewal | Monitor INR as outpatient and decide when to D/C LMWH (see AC Service guidelines) | ||||
| If pt not followed by UM AC Service, consult w/ pt's personal physician to determine when LMWH should be D/C'd. | Monitor INR for duration of warfarin therapy | Updates 9/06 |
