Proposal for establishing a Nurse-Led International Normalized Ratio Outpatient Clinic at The American University of Beirut Medical Center -

Abstract

Proposal for Establishing a Nurse-Led International Normalized Ratio Outpatient Clinic at The American University of Beirut Medical Center Anticoagulant’s use is common for treating and preventing cerebrovascular accident, cardiac disease, and thromboembolism in the outpatient setting. The use or misuse of these anticoagulants by patients, can lead to a significant harm despite its significant benefits. The risk of thromboembolic or bleeding complications will be increased with sub therapeutic or serotherapeutic levels relatively, as well as the healthcare cost. The direct and indirect cost of pulmonary embolism associated with atrial fibrillation for 177 patients over 2 years is equal to 13.6 million dollars (Hannon et al. 2014). Laboratory monitoring such as the International Normalized Ratio (INR) is the main constituent for a safe management of anticoagulant therapy. Not all out-patients at the American University of Beirut Medical Center who are maintained on anticoagulant therapy are being managed and closely followed-up from a centralized operation. Establishing an out-patient nurse-led international normalized ratio clinic is believed to be necessary to achieve optimal patients’ outcomes. According to the literature, INR clinics managed by nurses can reduce patients’ hospitalizations, complications and emergency room visits and hence reduce overall costs. To obtain a systemic process in the clinic, nurses should be well trained, follow a pre-printed protocol for managing anticoagulant dosing, adhere to a follow-up system and patient education. It has been proven that patients spend more time within their therapeutic target range when followed by an INR nurse-led clinic than a hematologist, in addition nurses are superior in managing patients newly maintained on anticoagulants. Furthermore, patients spend more time with the nurse discussing several aspects for their treatment which will lead to better patient education and knowledge.