IPEC 502: Interprofessional Quality Improvement and Patient Safety
Carla's Case Study
Advanced Case Study Developed by Karyn Baum, MD, MSED, Associate Professor of Medicine, University of Minnesota. Retrieved from IHI. org
Learning Objectives: At the end of this activity, you will be able to:
Analyze a complex case using concepts and skills related to quality improvement, patient safety, and other disciplines relevant to system-level improvement. Develop a specific plan to improve the "gap" in the system of care, including defining key measures and proposing changes, as part of an interprofessional team. Anticipate likely challenges to planned improvements.
The Case
Note: In order to make the most of this case, it may help you to know a little bit about blood thinners and the risks associated with them.
Warfarin is in a class of medications called anticoagulants or blood thinners. It works by decreasing the clotting ability of the blood. Warfarin is used to prevent blood clots from forming or growing larger in your blood and blood vessels. It is prescribed for people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have suffered a heart attack. Warfarin is also used to treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism (a blood clot in the lung).
The International Normalized Ratio (INR) is a measure of the level of anticoagulation of the blood Because warfarin can cause severe bleeding, "the safety and effectiveness of warfarin therapy depends critically on maintaining the INR within the therapeutic range." If the INR level is too low, a patient could be at high risk for a clot. If it is too high, the patient could be at high risk for a life- threatening bleed. All patients on warfarin need to have their INR checked and their dose adjusted on a regular basis.
Carla's Story
Carla is a 29-year-old woman with renal failure from polycystic kidney disorder, a congenital disease that requires her to undergo frequent dialysis. For several years, she has lived in a suburb of a medium-sized city in the American southwest. Carla is single and works part-time at a small printing company. Her boss offers her the flexibility to get to her dialysis appointments -- which last three hours if the center is running on time -- but the time away from work is a strain for Carla and for her boss.
It isn't easy for Carla to get to her dialysis appointments three times a week. She recently had to give up her car because she could no longer afford car payments and insurance, so she now relies on
emotional support; she gives Carla rides if she's able to get time off work, but that is rarely possible. Carla has a few close friends who provide her with a strong social network, but because Carla's appointments take so long and happen during business hours on weekdays, she usually has to go by herself. Carla's father lives on t