Hi, this is Amanda Jensen, I am the Structural Heart Navigator at Manatee Memorial Hospital and we will be discussing the shared decision making process with Watchman. Shared decision making is a collaborative process that allows patients and their providers to make healthcare treatment decisions together, taking into account the best scientific evidence as well as the patient's values and preferences. Who can participate in and document a shared decision? The patient's primary care physician, their cardiologist, or other areas of specialty might be neurologist, hematologist, gastroenterologist, urologist, or other specialties that you may come across who sends a patient for Watchman. Another area also may be the physician, if they're the non-implanter, who may perform the pre-Watchman transesophageal echocardiogram. They can also have this discussion with the patient. How to ensure you have a non-implanter shared decision making note? Once you receive a referral for Watchman, it is important to review all of the records received to ensure there is proper documentation and mention of the need for Watchman. If you are missing any information supporting this need, you can request the referring fill out a shared decision form if your site has created one, or ask them to send another note or documentation supporting and as to the why they are sending the patient for Watchman. If the referring is the implanting physician, there are several ways that you can obtain a non-implanter shared decision making note. One is to ask the primary care physician to either see the patient or fill out a non-implanter shared decision making form. Another might be the implanting physician at their consultation with the patient may ask one of their partners or colleagues to have that discussion during that visit with the patient or schedule a separate visit with them to complete. A third option may be depending on where your patient is in the process, if they are being scheduled for a pre-Watchman TEE or transesophageal echocardiogram, you may ask that physician performing the TEE as long as they are a non-implanter to also have that shared decision discussion with the patient and ensure that they document this in their note. As you are reviewing the referring physician's documentation to ensure that the patient does qualify or what the need is for Watchman, here are some key terms that you may find within that documentation. It is important that there is something documented that the patient is unable to tolerate long-term use of oral anticoagulation but are able to use it for a short term. Some of the many reasons that you may come across as to the why they need Watchman are as follows, the patient may have a history of gastrointestinal bleed, rectal bleeding, bleeding ulcers, hematuria, epitaxis, active lifestyle occupation that has them at risk for injury while they're on a blood thinner, falls or fall risk, subdural hematoma, anemia requiring multiple blood transfusions, or intracranial hemorrhage. These are all different reasons as to why a patient may be in need of Watchman. Here is an example of a template that you can use for the non-implanter shared decision-making discussion. This can be incorporated in the non-implanting physician's note. You can also create this form and ask that they use this language in their own documentation or if and when a physician is performing the pre-Watchman transesophageal echocardiogram. If they are the non-implanter, you can have this preempted for them to review and sign and make sure that it is scanned into the patient's chart to ensure that this is documented appropriately. Here is another example of a non-implanter shared decision-making form. This is a template that you can use or incorporate from your site to send to referring physicians in the event that you don't have proper documentation from their notes to support the need for Watchman. This helps show them the criteria that is needed and creates an easy process and form that you can have them fill out and ensure this is scanned into the chart so you have proper documentation. All of these documents are helpful in obtaining an authorization when the time comes to schedule your patient for the procedure. It is important that you obtain this information and have it available prior to doing so. Another area to think about is outreach. It is important to educate your referring physician and their offices and staff on how to send and refer a patient for Watchman. While doing this, you can also help educate them on ensuring they are documenting properly that non-implanter shared decision-making discussion with their patient. Some ways you can do this is by Lunch and Learn with their referring or primary care offices and their staff. You can also help promote your program on your hospital website and providing screening tools accessible on there. Another way is to have the implanter do lectures within the hospital to other physicians, hospitalists, and residents. It's very important to provide offices with your referring information. You can include any education brochures for patients from your facility. Most importantly, you can include, if your site has one, a non-implanter form for the referring to have to fill out and include in their office note. This helps lay out the criteria for Watchman to ensure they are sending the right patients, and it also helps you provide that documentation when you're going to schedule the patient for the Watchman procedure. Here are some other resources that may assist you in obtaining and creating a shared decision-making tool for your Watchman patients and referring physicians. Many of these sites are helpful in providing aids that you can provide to those physicians or create your own for your site and helps you ensure you have all the proper documentation in place in creating that shared decision-making discussion with the patients. In conclusion, always remember once you receive a referral for Watchman, ensure you have the documentation from the referring physician or obtain one in the many ways described before scheduling the patient for their procedure. Always send the referring an update on where the patient is at in the process after implant and 45-day follow-up TEE. Always reach out to referring offices to ensure they are educated in the referring process, have non-implanter forms and checklists to help facilitate their referral.

shared decision-making

Watchman

healthcare treatment decisions

scientific evidence

patient's values and preferences