Self-monitoring and self-management of oral anti-coagulation therapy practice - Essay Example

? Self-Monitoring and Self-Management of Oral Anti-Coagulation Therapy Practice Introduction Today’s healthcare practice is changing rapidly and thus, provision of patient care and management is shifting from institutional based management to home-based care where patients can test their status and manage the condition, especially for medical conditions that are not curable but only manageable such as diabetes. One of the testing and management practice being prompted and is gaining popularity in the healthcare sector is the Oral Anti-Coagulation Therapy Practice for patients (Ansell, et al., 2005). This paper concerns the designing of a plan aimed at changing our patients habit from that of going to the lab in hospitals and other healthcare facilities just to get their International Normalized Ratio (INR) testing done to getting these patients who have the capacity to learn how to use a home based testing device for INR instead of seeking lab based testing. The idea behind this concept is the fact that this process is fairly simple and if patients are well educated, they can easily do the test accurately and without any hustle (Baglin, et al., 2005). Besides, home based INR testing devices will be able to give results required in a very short while, actually immediately, just like it is the case for those diabetic patients who normally test for their daily levels of glucose. This is not the case when they seek lab based testing since the process takes 24 hours to get the results due to the large number of patients who might need the same service and the fact that in many instances, the medical practitioners do not match the number of patients. For that reason, the therapeutic range required for INR level will be easily achievable. To support this kind of argument, evidence based change practice design illustrated by Rosswurm and Larrabee’s (R & L) model for EB change will be made use of in presenting this paper. The evidence-based model for change: Self-Monitoring and Self-Management of Oral Anti-Coagulation Therapy Patients with long-term medical conditions can be educated to self-monitor and manage their conditions well. However, when it comes to the OAT, most physicians are normally reluctant to give a prescription because of the fear for encountering hemorrhagic complications (Levine, et al., 2004). It is a medical fact that any change in the health, lifestyle or drugs in a patient’s life could quickly interfere and alter the oral anticoagulant’s effectiveness in managing such conditions. What makes it even worse is the fact that each patient reacts differently to these drugs thus the need for regular monitoring of the therapy. However, I tend to think, based on reviews done, that there are strategies that could be used to improve the situation and have these patients self-monitor and self-manage their condition. The evidence based model for change has been derived from a thorough theoretical and research literature that is related to various research utilizations, change theory and the current evidence-based practice within the field (Rosswurm, 1992). This model has a guideline to medical practitioners for changing the normal practice to evidence based practice. Various stages have been proposed for effective implementation of this model. These start with step one where the need for change in the healthcare practice is done. In regard to this, the carrying out of an Oral Anti-Coagulation Therapy at home has been identified as the need for change where patients would have to test and manage their condition at home as is opposed to seeking lab testing. The need is therefore to help patients test their condition at home to establish their INR level within the required range. The reason for doing this comes from the fact that patients have been dissatisfied with the current trend of lab based testing which takes longer to process. The quality of the data got will also be reliable since it will be fresh and immediately established for quick action to be taken in managing the problem (Rosswurm, et al., 1999). The next step is to look at the link the problem with measures or interventions and outcomes. The problem that makes it hard and creates fear of allowing patients to self-monitor and self-manage the oral anticoagulants is simply the fear of hemorrhagic complications. This could be linked to establishment of the right INR level that is required for each patient since administration of these drugs depend on the range for each patient. This link does facilitate communication required among practitioners, gives necessary standards to determine the cost-effectiveness of the care and also establish need for resources to be provided. The 3rd step in this change process should deal with the synthesizing of the best evidence (Rosswurm, et al., 1999). There is need to combine the evidence collected with the best clinical judgment and the available contextual data. Various strategies could be used to help patients self-monitor and self-manage the oral anticoagulants. These would include educating the patients on the need to adhere to the requirements set out for testing and managing these drugs. The level of intensity of this therapy and therapeutic range seem to be the critical determinants when it comes to the achievement of therapeutic effectiveness and subsequent reduction of hemorrhagic risks. As long as the INR can be kept within the required therapeutic range by the patient, the prescription can be given. The next step will be to design a change in practice and this should be done in the best way possible. The current lab based practice incorporates testing and administering the anticoagulant and then monitoring the patient for 2 to 7 days when the anticoagulant effect takes place (Beyth, et al., 1996). The change design takes into consideration factors affecting the normal management of the oral anticoagulant therapy, which include interaction of drugs, illness affecting pharmacokinetics of these drugs, diet, GI factors that do affect vitamin K1, and or physiological factors deterring metabolic fate of these vitamin K-dependent coagulants. Patient’s adherence to the given plan for therapy is very necessary. In this self-management design, the physician is still necessary and makes appropriate dosing and other follow-up decisions to the patient. There is a need to come up with a comprehensive management of the identified variables. A knowledgeable provider should therefore; be assigned, a follow-up system that is well organized is necessary, there needs to be a prothrombin time (PT) monitoring that is very reliable, good communication and patient education is also of essence. Finally, computerized decision support systems could be put to use on this patients that have been seen to be able to carry out the process by them. This is because the computer system is able to predict the dosage requirements based on any adjustments made in the life of the patient as mentioned. It can also establish the time interval required for the next test. This kind of both manual and computerized management design will prove effective for this process (Rosswurm, et al., 1999). The 5th step will entail the implementation and evaluation of the change practice which could be done by having a pilot project that is carried out based on a sample population of patients (Rosswurm, et al., 1999). This is to ensure that the process is effectively monitored and reinforced. Medical staff will be deployed to monitor the situation, ask questions and come up with information that could help in the prescription process. The effectiveness of the process will be measured and analyzed accordingly. The feedback from the staff will help make an informed decision on whether to accept or reject this change proposal. Based on the evidence at hand, there is no doubt that the process will be successful. The outcomes expected in this project are that the patients will be able to closely follow instructions and manage their condition effectively without need to go to labs and hospitals. With effective monitoring and management, the hemorrhagic complications are also not expected to appear. The patients should be able to administer the oral anticoagulants as will be prescribed by the physicians (Hylek, et al., 2001). The 6th step would incorporate integration and maintenance of the change practice. This will majorly depend on the pilot project (Rosswurm, et al., 1999). The patients will be given INR level testing kits and prescription given for self-monitoring and management of the oral anticoagulant therapy. Self-monitoring and self-management of this therapy requires that the patient be well educated. Conclusion The other strategies identified include constant communication between the patient and the assigned health professional, monitoring of various variables that may affect the process such as diet as mentioned above. Systematic review of the patient and meta-analysis of the situation should be done to ensure that there are no cases associated with hemorrhagic complications. The patient also needs to be trained and made aware of the need for constant or frequent testing to establish his or her INR levels on a daily basis. 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