Step Description Key Point / Image / Reason Who Time 1. Statins are 1st line therapy to prevent Standard treatment protocols Clinician ASCVD. Statin intensity and dose should approved by Atrius Health Pharmacy guide therapy: and Therapeutics Committee for High Intensity (LDL reduction treatment of hyperlipidemia with • ≥ 50%): atorvastatin 40mg/80mg; Crestor statin medication. Click for the 20mg/40mg document. Moderate Intensity (LDL • reduction 30-49%): atorvastatin 10mg/20mg, pravastatin 40mg/80mg, simvastatin 20mg/40mg, lovastatin 40mg 2 Clinician requests treatment with statin Clinician forwards request for statin Clinician During or intensification of statin treatment treatment to RN, indicating Roster medication/dose/directions either via Review telephone encounter or result note. meeting, or other time via telephone encounter or result note. 3 RN reviews clinician directive and LDL RN Upon values. If statin naïve check for baseline Clarify actions to be by RN receipt of LFT in past 12 months. request If no LFT in past 12 months, check LFT before proceeding with standard work. 4 Access or create telephone Documentation venue RN Initiation of encounter/result note from clinician to RN contact document patient counseling and with patient medication/lab orders via RN smartphrase (.statins). Add diagnosis code appropriate to patient or ask clinician for clarification. 5 Communicate clinician advice, Documentation venue RN During medication education including phone drug/dose/adverse effects/monitoring to conversation patient and document in encounter. with patient 6 Patient declines treatment initiation or Decision point RN During intensification. Forward request back to telephone clinician for follow up. DO NOT encounter CONTINUE STANDARD WORK. 7 If patient agrees to plan, request patient Reinforces preferred HVMA RN During obtain statin medication at HVMA pharmacy use. telephone pharmacy—confirm location or identify encounter
Step Description Key Point / Image / Reason Who Time 1. Statins are 1st line therapy to prevent ASCVD. Statin intensity and dose should guide therapy: • High Intensity (LDL reduction ≥ 50%): atorvastatin 40mg/80mg; Crestor 20mg/40mg • Moderate Intensity (LDL reduction 30-49%): atorvastatin 10mg/20mg, pravastatin 40mg/80mg, simvastatin 20mg/40mg, lovastatin 40mg Standard treatment protocols approved by Atrius Health Pharmacy and Therapeutics Committee for treatment of hyperlipidemia with statin medication. Click for the document. Clinician 2 Clinician requests treatment with statin or intensification of statin treatment Clinician forwards request for statin treatment to RN, indicating medication/dose/directions either via telephone encounter or result note. Clinician During Roster Review meeting, or other time via telephone encounter or result note. 3 RN reviews clinician directive and LDL values. If statin naïve check for baseline LFT in past 12 months. If no LFT in past 12 months, check LFT before proceeding with standard work. Clarify actions to be by RN RN Upon receipt of request 4 Access or create telephone encounter/result note from clinician to document patient counseling and medication/lab orders via RN smartphrase (.statins). Add diagnosis code appropriate to patient or ask clinician for clarification. Documentation venue RN Initiation of RN contact with patient 5 Communicate clinician advice, medication education including drug/dose/adverse effects/monitoring to patient and document in encounter. Documentation venue RN During phone conversation with patient 6 Patient declines treatment initiation or intensification. Forward request back to clinician for follow up. DO NOT CONTINUE STANDARD WORK. Decision point RN During telephone encounter 7 If patient agrees to plan, request patient obtain statin medication at HVMA pharmacy—confirm location or identify Reinforces preferred HVMA pharmacy use. RN During telephone encounter
RN-Step4-HVMA-LDL%20protocol-2016.docx