Policy Manual sample

MDT Home Health Care Agency, Inc. HOME PT / INR MONITORING POLICY POLICY: It is the policy of our Agency to recognize the use of Home Prothrombin Time/ International Normalized Ratio Monitoring for Anticoagulation Management as appropriate and consistent with good medical practice when performed for the indications listed in this policy. DEFINITIONS Anticoagulant: an agent used to prevent the formation of blood clots Deep Vein Thrombosis: a blood clot that occurs in the veins of the inner thigh or leg Home PT/ INR Monitoring device: a portable testing device that includes a finger-stick and an FDA approved monitor that measures the time it takes for a person’s blood to clot International Normalized Ratio (INR): is the international normalized ratio of the patient’s prothrombin time compared to the mean prothrombin for a group of normal individuals in order to standardize the results. (INR = patient PT divided by mean normal PT). Prothrombin time (PT): a test that evaluates the blood’s ability to clot properly. PT/INR is the standard measurement for therapeutic effectiveness of warfarin therapy. Therapeutic index: the dose of a drug required to produce a desired effect Thromboembolism: blocking of a blood vessel by a blood clot Warfarin (Coumadin): is an anticoagulant drug (blood thinner) used for the treatment and prevention of venous and arterial thrombosis PURPOSE: The purpose of this policy is to define the appropriate indications for coverage of Home PT/ INR Monitoring. PROCEDURE: A. Medical Description / Background Anticoagulation therapy is recommended in the prevention and/or treatment of venous thromboembolism, chronic atrial fibrillation and for patients with artificial heart valves. Warfarin (Coumadin) is the most commonly used oral anticoagulation agent and suppresses the action of vitamin K which is responsible for the activation of specific proteins that form and maintain a clot. Three million people in the United States are treated with Coumadin. It is a potentially hazardous drug because it can produce major bleeding. The incidence of bleeding is related to the degree of anticoagulation. For this reason, patients are periodically monitored with a prothrombin time measurement. The results are measured in seconds (normal is 11-15 seconds) and then compared with the value known as the INR. To determine the INR, the ratio of the patient’s PT is compared to the average of a group of normal individuals. The dose of Warfarin is adjusted to achieve a therapeutic effect with an INR range of 2.0 to 3.0 for most clinical indications although the therapeutic dose range varies for each patient and specific indication. Levels lower than 2.0 may result in strokes and levels greater than 4.0 nearly double the risk of hemorrhage. There are three sites for obtaining and monitoring a patient’s anticoagulation therapy: a physician’s office, a clinical laboratory or home PT/INR monitors. These monitors are portable devices used to monitor blood-clotting rates by patients at home with a goal of increasing the time that anticoagulation is within a therapeutic INR range and to decrease the incidence of a thromboembolic or hemorrhagic event. Home prothrombin monitors produce results similar to laboratory-based measurements with results available in minutes. The authorized field staff doing Home Health Agency Nursing Care & Procedures K-168