Date of Completion

Spring 5-11-2022

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Eileen Stuart-Shor PhD, ANP-C, FAHA, FAAN

Site Advisor

Ricihard Pollard M.D.

Second Reader

Ashley Lowery MSN, AGNP-BC

Abstract

Background: Arranging periprocedural antithrombotic medication (ATM) management is a frequently encountered complex clinical challenge. Often, there is limited time between the pre-admission clinic visit and the surgical date to coordinate ATM management and communicate the plan to the patient. This increases the risk of perioperative adverse events, case delays and cancellations, and is a patient safety concern. A quality improvement project was undertaken to address improving ATM periprocedural care coordination for patients taking ATM undergoing elective surgery. A review of the literature found clinical decision support system (CDSS) alerts to be an effective strategy. The aim of the project was to improve the quality and safety of ATM by optimizing the care coordination pathway for periprocedural ATM management.

Methods: A multidisciplinary team was formed to collaborate on the project aims,intervention, and implementation plan. The intervention was a computer application for auto-identification and flagging of ATM to deploy a CDSS alert for referral to an online workflow organization tool (list manager) to coordinate ATM periprocedural management. Current state analysis was conducted.

Results. Qualitative and quantitative evidence demonstrated variation across surgical services in coordinating periprocedural ATM management. This data supported project approval by senior leadership. Request for programming was submitted. Planning for piloting the intervention in two clinical areas where bleeding is of critical concern continues.

Conclusion. The project was complex in both scope and design, affecting multiple stakeholders with competing concerns. In the first iteration, the request for programming the CDSS alert was denied. This required the project team to pivot to an alternative solution, an online workflow organization tool (list manager) and extended the project timeline.

Recommendations: This quality improvement project demonstrates the need for further quality improvement initiatives and research on improving the coordination of periprocedural ATM management. It highlights the complexity of this care coordination process.

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