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Abstract
Purpose
Coumadin identified by Institute for Safe Medication Practice as high–risk medication with narrow therapeutic window and high risk of life threatening adverse effects
Anticoagulants identified as one of the top five drug types associated with patient safety incidents
Maintaining INR in recommended therapeutic ranges reducing the incidence of adverse effects
Improve INR–TTR(time in therapeutic range) in patients managed through the Coumadin Clinic
Comply with nationally established INR goal guidelines
Methods
Develop routine order sets
Define team roles/expectations
Develop point–of–care resource optimising access to INR testing.
Educational program targeting stakeholders
Monthly meeting auditing patients with goal analysis utilising tracking tools
Review of process/outcome measures.
Intervene for change utilising PDSA methodology
PDSA Cycle 1:
Retrospective data collection–2008
No systematic approach in place/data regarding patient TTR not available
No structured staff/patient education program
PDSA Cycle 2:
Implement changes
Web–based software purchased
Structured approach to INR management implemented including stakeholder education program
PDSA Cycle 3:
Problem monitoring/notifying overdue INR patients
Team member roles/responsibilities redefined
‘Buddy system’ implemented to monitor/notify overdue patients
Results
TTR increased from 66%-2008 to 79%-2013 following implementation of structured policies/programs
Re–implementation of education program, revision of policy/procedures TTR increased to 80% Jan–May–2015
Optimized point–of–care for INR testing–office finger–stick/remote laboratory testing/home monitoring
Increased INR home monitoring
Conclusion
With development of systematic approach to high risk patients on anticoagulation therapy, using a web–based software program, significant changes were evident:
Improved patient follow–up, communication, decrease in overdue patient numbers
Increased percentage of patients’ within INR range
Approach driven by the PDSA CQI methodology