The purpose of this study was to evaluate whether a new anticoagulation
management program resulted in better monitoring of warfarin, increased
warfarin patient education prior to discharge, and fewer bleeding
complications associated with warfarin.
A retrospective chart review was conducted of patients who were inpatients
and received warfarin from April 1, 2008 to July 31, 2008 (control group)
and from April 1, 2009 to July 31, 2009 (after implementation of the new
anticoagulation program). The frequency of warfarin-related laboratory
orders that included international normalized ratios (INRs), complete blood
counts (CBCs), and documented patient education by pharmacy, nursing, and
dietary services were determined before and after program implementation.
Also, data was collected to determine frequencies of bleeding complications
associated with warfarin.
There were 112 patients in the pre- and 115 patients in the post-program
group. After implementation of the inpatient warfarin management program,
obtaining baseline INRs increased from 74% to 90% (p=0.001). Orders for
baseline CBCs increased from 85% to 94% (p=0.026). Obtaining CBCs every 3
days increased from 54% to 74%, (p<0.001). However, there was no
significant change in orders for daily INRs (p=0.055). Education by nursing
increased from 54% to 80%, (p<0.001), by pharmacy increased from 8% to
76%, (p<0.001), and by dietary increased from 11% to 79%, (p<0.001).
Documentation by all three disciplines in each patient increased from 3.6%
to 59%, (p<0.001). Significantly fewer patients received vitamin K and/
or fresh frozen plasma for supratherapeutic INRs with bleeding complications
after the program was initiated compared to baseline (p=0.009).
The implementation of an inpatient warfarin management program led to better
monitoring of patients receiving warfarin, and increased patient education.
However, a larger and longer assessment is necessary to determine if these
changes are maintained and how these changes affect long-term clinical