Resources for Addressing Specific Risk Factors
PROJECT BOOST Risk Factor Mitigation: Discharge Preparation & Education Resources
Risk Area
Medication safety: Warfarin
Related Quality Measures [if any]
Joint Commission Patient Safety Goals
http://www.jointcommission.org/standards_information/npsgs.aspx
Impact on Patient Care and Safety
Receipt of warfarin therapy increases bleeding risk and emergency department visits. There are both patient and system-level factors that contribute to the increased risk and these must both be addressed in order to optimize the safe administration and monitoring of warfarin therapy.
Patient-level factors may include 1 -
- previous history of gastrointestinal bleeding in the past 18 months
- previous hospitalization with an alcohol-related diagnosis in the previous 18 months
- chronic renal disease
- age over 65 years old
- presence of a malignancy
- female gender
- nonwhite race
System level factors have been less well studied but may include -
- lack of systematic monitoring
- identification of important drug interactions
- patient/caregiver education about medication adherence
- patient/caregiver education about monitoring
Key Communication & Education Objectives
In bullet format, list the specific communication objectives. Objectives should be precise and clearly indicate the knowledge / actions the patient / caregiver should be able to demonstrate.
- Knowledge that the patient is on warfarin
- Knowledge about the indication for warfarin and the proposed duration of therapy
- Knowledge about the dosing schedule
- Knowledge about important drug interactions
- Knowledge about nutritional and food issues on warfarin
- Action plan if patient has a fall or injury - especially a head injury
- Use of other anticoagulants in conjunction with warfarin
- Who to call if there are questions about dosing, side effects
Selected Evidence Based Patient/ Family/ Caregiver Interventions & Education Materials
Warfarin-monitoring clinics/ Telephone support -
Wilson SJ, Wells PS, Kovacs MJ, Lewis GM, Martin J, Burton E, Anderson DR. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial. CMAJ. 2003 Aug 19;169(4):293-8.
Matchar DB. Do anticoagulation management services improve care? Implications of the Managing Anticoagulation Services Trial. Card Electrophysiol Rev. 2003 Dec;7(4):379-81.
Matchar DB, Samsa GP, Cohen SJ, Oddone EZ, Jurgelski AE. Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial. Am J Med. 2002 Jul;113(1):42-51.
Wittkowsky AK, Nutescu EA, Blackburn J, Mullins J, Hardman J, Mitchell J, Vats V. Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting. Chest. 2006 Nov;130(5):1385-9
Pharmacist-support programs
Witt DM, Sadler MA, Shanahan RL, Mazzoli G, Tillman DJ. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest. 2005 May;127(5):1515-22.
Poon IO, Lal L, Brown EN, Braun UK. The impact of pharmacist-managed oral anticoagulation therapy in older veterans. J Clin Pharm Ther. 2007 Feb;32(1):21-9.
Additional Patient/ Family/ Caregiver Interventions & Education Materials
AHRQ Guide to Help Patients on Coumadin®/Warfarin Therapy
http://www.ahrq.gov/consumer/coumadin.htm. Accessed August 7, 2008
Listing Professional Education Materials
List specific professional education materials including: slide sets, case studies or guidance for integration of risk reduction strategies into residency curricula.
References
1. White RH, Beyth RJ, Zhou H, Romano PS. Major bleeding after hospitalization for deep-venous thrombosis. Am J Med. 1999 Nov;107(5):517-8.
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