Twenty-four (60%) respondents agreed that periodic, personalized feedback on use of less frequent INR testing would also be helpful. Most survey responders ( n = 24 60%) agreed that an eligibility flag in the electronic medical record would be very helpful. In the survey (65% response rate), staff report offering less frequent INR testing to 56% (46–66%) of eligible patients. Resultsįrom the interviews, four themes emerged congruent with TICD domains: (1) staff overestimating their actual use of less frequent INR testing (individual health professional factors), (2) barriers to appropriate patient engagement (incentives and resources), (3) broad support for an electronic medical record flag to identify potentially eligible patients (incentives and resources), and (4) the importance of personalized nurse/pharmacist feedback (individual health professional factors). Informed by interview themes, a survey was developed and administered to all anticoagulation clinical staff ( n = 62) about their self-reported utilization of less frequent INR testing and specific barriers to de-implementing the standard (more frequent) INR testing practice. Interview guides were based on the Tailored Implementation for Chronic Disease (TICD) framework. Using a mixed-methods approach, we conducted post-implementation semi-structured interviews with a total of eight anticoagulation nurse or pharmacist staff members at five participating clinic sites to assess barriers and facilitators to de-implementing frequent international normalized ratio (INR) laboratory testing among patients with stable warfarin control. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative. De-implementation efforts aim to reduce the use of low-value clinical practices. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). Our fax number is 50.Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Health Care Financing Administration (HCFA)Īll orders should be faxed to ensure availability at all blood drawing stations.Commonwealth of Massachusetts Department of Public Health (DPH).The BID Plymouth Laboratory is licensed and/or accredited by: Urinalysis: studying a urine sample in the lab.Serology: the scientific study of fluid components of blood, especially antigens (diseases, toxins or other substances that enter your body) and antibodies (the blood proteins that fight antigens).Microbiology: the scientific study of microorganisms.Phlebotomy: taking a blood sample from your body using a needle.Pathology: studying the structure of normal, abnormal, diseased or injured tissue.Histology: studying the microscopic structure of your body's tissues.Hematology: testing your blood and blood-forming tissues, and diagnosing blood conditions.Cytology: checking the formation, structure and function of your cells.Coagulation: testing how your body clumps blood cells together to form a clot.Chemistry: determining the presence and/or amount of certain substances in the body. ![]()
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