Reduction in anticoagulation-related adverse drug events using a trigger-based methodology

Area of Science:

• Pharmacovigilance
• Medication Safety
• Health Systems Management

Background:

• Novant Health System initiated a program to mitigate warfarin-related adverse drug events (ADEs).
• The strategy employed lab-based International Normalized Ratio (INR) triggers and pharmacy-based Vitamin K triggers for patient-specific monitoring.
• The initiative aimed to decrease warfarin-associated ADEs in both inpatient and outpatient care settings.

Purpose of the Study:

• To implement and evaluate a system for reducing warfarin-related ADEs.
• To establish patient-specific triggers for proactive intervention in warfarin therapy.
• To improve medication management protocols for anticoagulation therapy.

Main Methods:

• A hospital information system generated monthly lab and pharmacy triggers during seven-day sampling periods.
• Clinical pharmacists reviewed all identified patient charts based on these patient-specific triggers.
• Preliminary harm classification using the NCC MERP index was performed by pharmacists for each patient.

Main Results:

• Warfarin-related ADEs decreased by 45% in inpatient management.
• Warfarin-related ADEs decreased by 52% in outpatient management.
• The system demonstrated effectiveness in reducing ADEs through targeted interventions.

Conclusions:

• The implemented trigger system proved effective in reducing warfarin-related ADEs.
• The initiative, while based on inpatient triggers, provided a viable outpatient model.
• Improvements were observed in outpatient physician intervention groups, highlighting the model's adaptability.