AJM onlineClinical research studyImproving Warfarin Management Within the Medical Home: A Health-System Approach
Section snippets
Standardizing Warfarin Management
The AAC created a workgroup to spearhead this initiative. The workgroup was led by the Anticoagulation Stewardship Program pharmacist and included primary care physicians, frontline nurses and pharmacists, clinic operations managers, and technical system support members.
The workgroup identified best practices through a comprehensive literature and Web search of published warfarin management guidelines and protocols. From there a delegation protocol was created that allowed physicians to
Results
In the fall of 2009, the AAC workgroup created a delegation protocol for warfarin management. It provides step-by-step instructions on how to initiate a patient on warfarin therapy, complete a patient assessment (Figure), calculate warfarin dose adjustments, and monitor an INR; it defines what information should be documented in the EMR and outlines patient education needs. The protocol was approved for use by our AAC Committee, Pharmacy and Therapeutics Committee, and Medical Board. The
Discussion
Our study shows that the implementation of a standardized warfarin management program across a health system was successful in improving the TTR. Additionally, implementing a standardized electronic documentation system also improved the documentation of the warfarin management plan, including: indication, INR goal, warfarin dose, and time to next INR, and allowed all providers access to the warfarin management information. It also provided the opportunity to create real-time registries for
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Funding: None.
Conflict of Interest: All authors confirm no conflicts of interest.
Authorship: All authors had access to the data and had a role in development of the study, access to, and evaluation of the study data and in preparation and review of the manuscript.