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04/15/19 GK -- post cardiac cath and existing UFH/LMWH orders

From: Gregg Knowles

Sent: Monday, April 15, 2019 1:14:50 PM

Subject: post cardiac cath and existing UFH/LMWH orders

It is not uncommon for patients presenting with chest pain to be placed on UFH/LMWH prior to going to cath.  The old paper Post Cardiac Cath Order Set called for discontinuation of the UFH/LMWH.  It is difficult to include a d/c order into a 1Chart powerplan, and we are finding in the Cerner world, the UFH/LMWH is remaining on the profile after cath.  Pharmacy is working on long term solutions.  In the meantime, RPhs familiar with the old paper order set cannot assume the UFH/LMWH order should be d/c'd after cath.  There are a small percentage of patients who need to be on long-term anticoagulation and should have the UFH/LMWH con't after cath as a bridge to Coumadin.  As inconvenient as it may be, if there is any question as to whether the UFH/LMWH should continue, the MD should be paged for clarification.  I realize it is difficult to get a hold of MDs who are in procedures all day, but we cannot take it upon ourselves to assume the MD meant to d/c a drug.  As I mentioned, pharmacy is working on long-term solutions, so hopefully resolution of this issue will be in the near future.

Gregg K.