CONTACTS 

SUBJECTS
Pulmonary Emboli Order End Coumadin Treatment for Blood Clots Mistak

2103 -
2103 -    ..
2104 - Summary/Objective
2105 -
210501 - Follow up ref SDS 12 0000. ref SDS 11 0000.
210502 -
210503 - Gloria received the message on the doctor ending Coumadin treatments,
210504 - and is coordinating to get formal notification from the doctor that he
210505 - ended Millie's treatment for pulmonary emboli. ref SDS 0 WN9O
210506 -
210507 -
210508 -
210509 -
210511 -  ..
2106 -
2107 -
2108 - Progress
2109 -
210901 - Gloria is a nurse in the Kaiser Coagulation Treatment Clinic located
210902 - in Martinez, CA.  She manages Millie's Cuomadin treatments and blood
210903 - tests to prevent recurrence of pulmonary emboli.  On 051006 Gloria
210904 - explained Kaiser policy to stop Coumadin treatments a maximim of 5
210905 - days in advance of surgery, and to resume treatment after surgery, and
210906 - on the same day when surgery is performed. ref SDS 12 5E6O  At that
210907 - time, on 051006 Gloria further asked that, during a meeting the next
210908 - day, Millie explain Kaiser policy to the primary care physician on
210909 - pausing Coumadin treatments for surgical procedures. ref SDS 12 5F62
210911 -  ..
210912 - On 051007 Millie explained the policy to the doctor, as related by
210913 - Gloria the day before.  However, the primary care physician ended
210914 - Millie's treatment with Coumadin for pulmonary embolism. ref SDS 13
210915 - XN7K
210917 -  ..
210918 - On the day of surgery, 051021, Millie suggested calling to remind
210919 - Gloria that the primary care physician ended Coumadin treatments.
210920 - ref SDS 15 QW6H  Gloria was called later that day after surgery, and
210921 - notified that Millie did not resume Coumadin treatments, ref SDS 15
210922 - RR9G, as Gloria had planned during the call on 051006 when she
210923 - explained Kaiser's standard practice. ref SDS 12 5E6O  This was a
210924 - backup courtesy call in case the primary care physician did not have
210925 - time to notify the Coagulation Treatment Clinic of the decison on
210926 - 051007.
210928 -  ..
210929 - Today, Gloria called Millie and said she got the message on 051021
210930 - that the doctor stopped Coumadin treatments. ref SDS 15 RR9G
210932 -  ..
210933 - Gloria appreciated courtesy notice from the patient on 051021.  She
210934 - said that the Coagulation Treatment Clinic requires an order from the
210935 - primary care physician to end treatment for pulmonary emboli, because
210936 - Kaiser requires lifetime treatment for cancer patients, and Millie has
210937 - stage IV cancer status.  This policy was cited by the primary care
210938 - physician on 051007, ref SDS 13 QG5H, and earlier by the backup doctor
210939 - on 041104, telling Millie she would require treatment for pulmonary
210940 - emboli for the rest of her life. ref SDS 5 4Y9G  Gloria said that
210941 - treatment conflicting with policy requires official authorization by
210942 - the doctor.
210944 -  ..
210945 - Gloria advised that Millie's doctor has not notified the Coagulation
210946 - Treatment clinic to end treatment for pulmonary emboli, as he ordered
210947 - on 051007. ref SDS 13 EQ7K  She has requested this formal notice from
210948 - the doctor to comply with Kaiser's requirements on records management,
210949 - quality control, etc.
210951 -      ..
210952 -     [On 051026 Gloria reported that the primary care physician changed
210953 -     the prescription on 051007 for ending Coumadin treatment, and
210954 -     ordered treatments resumed for pulmonary emboli, as required by
210955 -     Kaiser's guidance because Millie is a stage IV cancer patient.
210956 -     ref SDS 16 PO7J
210958 -      ..
210959 -     [On 051121 primary care physician ended Coumadin treatment for
210960 -     pulmonary emboli, and called the Coagulation Treatment Clinic in
210961 -     Martinez to confirm this change. ref SDS 17 RZ4I
210963 -      ..
210964 -     [On 060722 quality control on ending Coumadin treatments reflects
210965 -     research showing high risk for death from recurrence pulmonary
210966 -     emboli. ref SDS 18 BI5J
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2110 -