ZynxAmbulatory Updated Content

For information pertaining to new or withdrawn evidence and other changes affecting order sets and rules in the ZynxAmbulatory modules during April through June 2012, click here.

General Announcements

• ZynxAmbulatory now comprises 76 modules, 67 submodules, 59 forecasters, 227 rules, 117 order sets, and 37 care management checklists.
• The scope of the Transient Ischemic Attack (TIA) module has been revised to cover the initial workup of patients who present in the ambulatory setting with clinical features suspicious for TIA. The order set does not cover treatment once the diagnosis is confirmed nor does it include medications for long-term secondary prevention, which remain in the Stable Cerebrovascular Disease order set.

Clinical Highlights

• Atrial Fibrillation
  
  
• Due to an updated guideline on anti-thrombotic therapy for atrial fibrillation from the American College of Chest Physicians, the following reminders have been added to the order set:
  
  
• Consider the use of dabigatran in preference to warfarin, except for patients who have mitral stenosis, stable CAD, placement of an intracoronary stent, or patients with ACS who do not undergo intracoronary stent placement
• For patients who are at high or intermediate risk for stroke, oral anticoagulation with dabigatran or warfarin should be used

• Cerebrovascular Disease – Stable
  
  
• Due to an updated guideline on antithrombotic and thrombolytic therapy for ischemic stroke from the American College of Chest Physicians, an order item for dabigatran has been added, and the following reminders have been added or updated in the order set:
  
  
• For long-term secondary prevention, consider the use of clopidogrel or the combination of aspirin and extended-release dipyridamole, in preference to aspirin
• For patients with history of stroke or TIA associated with atrial fibrillation, consider the use of dabigatran in preference to warfarin
• For patients with history of TIA or ischemic stroke associated with atrial fibrillation or prosthetic heart valves, administer warfarin (alternatively, dabigatran for patients with atrial fibrillation)
  
  
  • The above reminder was changed from “Warfarin should be administered to patients with cerebrovascular disease (eg, history of TIA or stroke) associated with nonrheumatic atrial fibrillation or prosthetic heart valves”
    
    
• Coronary Artery Disease – Stable
  
  
• Due to an updated guideline on primary and secondary prevention of cardiovascular disease from the American College of Chest Physicians, the following dosage of aspirin has been removed from the order sets:
  
  
• aspirin 325 mg tab, delayed release (Note: “aspirin 81 mg tab, delayed release” remains)
  
  
• Prenatal Care
  
  
  • Due to an updated guideline on VTE, thrombophilia, antithrombotic therapy, and pregnancy from the American College of Chest Physicians, the following reminder has been added to the order set:
    
    
    • For patients at increased risk of preeclampsia, consider antepartum low-dose aspirin beginning in the second trimester
      
      
• Preventive Care and Screening – Adult
  
  
• Due to an updated guideline on screening for colorectal cancer from the American College of Physicians, the following reminder has been updated in the order sets:
  
  
• Consider colorectal cancer screening for high-risk patients (eg, African American, family history) starting at 40 years of age or 10 years younger than the age at which the youngest affected relative was diagnosed with colorectal cancer
  
  
  • The above reminder was changed from “Consider colorectal cancer screening in African American patients beginning at 45 years of age”
    
    
• Due to an updated guideline on primary and secondary prevention of cardiovascular disease from the American College of Chest Physicians, the following dosage of aspirin has been removed from the order sets:
  
  
  • aspirin 325 mg tab, delayed release (Note: “aspirin 81 mg tab, delayed release” remains)
    

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