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Customized Care for Those on Warfarin

Category: St. Luke’s Proud
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Jaclyn Wichlidal, RN, Lora Lee Chiaverini, RN, Tyler Hassel, PharmD, and Levi Youngmark, RN, all help patients with their warfarin dosage as part of St. Luke’s Anticoagulation Management Program.

St. Luke’s Anticoagulation Management Program supports patients taking anticoagulants in Duluth

Many live with the ongoing risk of developing blood clots. This is especially true for those who have had a heart attack or valve replacement surgery. If nothing is done to prevent blood clots from forming, they live with an increased risk of stroke and other heart issues.

To reduce this risk, these people typically take anticoagulant drugs. The most common anticoagulant is warfarin (Coumadin). This medication is extremely effective, inexpensive and has been used with proven success for decades.

But there’s a catch.

“Warfarin doesn’t play well in the sandbox, if you will,” said St. Luke’s Anticoagulation Management Program Nurse Jackie Wichlidal, RN.

St. Luke’s Anticoagulation Management Program

The dosage of warfarin a person needs for the drug to remain effective at preventing clots is fairly affected by lifestyle factors. This includes diet, activity, medications, supplements, sleep and stress. That means whenever these factors change, a patient’s warfarin dosage must change to maintain effectiveness.

That’s where St. Luke’s Anticoagulation Management Program comes in. This team of four nurses and a pharmacist works closely with more than 900 patients. They monitor patients’ ongoing lifestyle changes and adjust warfarin dosages to ensure effectiveness.

“We don’t want patients to base their lives around how much warfarin they’re taking,” said Wichlidal. “So, we instead stay in communication with them so we can adjust their warfarin dosages as needed.”

Education and communication are key

For patients new to warfarin, the team focuses on education and ensuring that each person’s dose is calibrated to their lifestyle. Ongoing check-ins help patients know how to adjust their dosage when they are sick or have any lifestyle changes.

These check-ins are done by phone. This is especially helpful for patients who spend part of the year in warmer climates. “Even if a patient lives somewhere else for six months a year,” said Wichlidal, “we still provide them with the same care and service.”

“We don’t want patients to base their lives around how much warfarin they’re taking.”

This one-on-one support is a primary reason the clinic thrives, said Lora Lee Chiaverini, RN. She has been with the program for 17 years. “We build long-term, trusting relationships with people,” she said. “This helps us effectively manage their dosages.”

An innovative program model

The program recently expanded its care with the addition of Pharmacist Tyler Hassel, PharmD. This approach, combining the expertise of nurses and a pharmacist, makes St. Luke’s unique among anticoagulation programs nationwide.

Hassel joined the team in the summer of 2022, after graduating from the University of Minnesota College of Pharmacy and completing his residency at St. Luke’s. As a pharmacist, he monitors medications, potential drug interactions and transitions of care. If a patient has an upcoming surgery, for example, Hassel works with the primary care physician to pause their warfarin usage and resume the medication when safe to do so.

One of his first projects was to develop and implement an electronic system to support the team’s efforts. This system works by immediately flagging medication changes for warfarin users within St. Luke’s. For instance, if a patient visits the Emergency Department or Urgent Care and starts a new medication, an alert notifies the Anticoagulation Team.

“The first thing I do every day is pull up that report,” Hassel said. If he spots any interactions or changes, he works with the nursing team to reach out to the patient. Their warfarin dosage can be modified right away, long before they’re at risk for a clot or bleed.

Patients with medication questions can call the team anytime.

Chiaverini finds this approach especially effective. “It ensures our patients’ warfarin is dosed on an individual basis, safely and in a timely manner.”

Patients with medication questions can call the team anytime. “We are a lifeline – a really good resource,” said Wichlidal. Talking with patients every day is her favorite part of her job. “They share their lives with us, the good and bad. If they’ve been sick, on vacation or just had a granddaughter, we get to hear about it.”

Patients appreciate the team, too – sending emails, cards, and even Valentines to show gratitude for their support.

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This article was originally featured on pages 46 & 47 in the May-June 2023 issue of The Woman Today magazine.