Expanded and efficient use of low molecular weight heparin/warfarin overlap therapy makes it possible to manage warfarin induction in the outpatient setting.  The care oversight provided by the Nursing Model for Anticoagulation Management makes early discharge from the hospital possible.  To date, the model has yielded hospital cost savings through LOS reductions of 4.63 days per admission on average.  Referrals to the service from inpatient areas increased 91% in fiscal year 2007.

In addition, nursing oversight during warfarin induction following discharge improves safety by preventing recurrent thrombosis and bleeding complications thereby reducing anticoagulation related readmissions to the hospital.

The Nursing Model for Anticoagulation Management team facilitated education and supported the hospital-wide practice change to low molecular weight heparin as the preferred agent to unfractionated heparin to capitalize on its potential to manage anticoagulation in the outpatient setting.

MGH has improved hospital-wide adherence to national guidelines for warfarin initiation best practice for warfarin-heparin overlap from 20% (were off heparin before warfarin therapeutic for two consecutive measurements) to 100%.

MGH improved achievement of prescribed therapeutic targets at immediate post-hospital follow-up from 51% to 75%.

Anecdotally, nurses express satisfaction with being able to provide individualized and comprehensive care to their patients and being able to develop strong relationships with their patients.  Physicians recognize nurse dedication to patients and helpful problem-solving skills.

AMS takes patient satisfaction very seriously, regularly soliciting and reviewing patient comments.  Anecdotal patient feedback with the program is very positive, and patients note feeling confident in the care they receive.