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Management of oral anticoagulation in a population of children with cardiac disease using a computerised system to
Juliet Soper1, George T C Chan, Jonathan R Skinner
1Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
Insights
A new computerized system for warfarin management maintained International Normalized Ratio stability in children. This system improved prescribing practices without increasing monitoring or dosage adjustments, ensuring safe anticoagulation care.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Health Informatics
Background:
- Warfarin is crucial for maintaining anticoagulation in pediatric patients.
- Effective warfarin management requires careful monitoring of the International Normalized Ratio (INR).
- Manual prescribing systems can be prone to errors and deviations from guidelines.
Purpose of the Study:
- To evaluate the impact of a computerized decision-support system on warfarin management in children.
- To assess the system's effect on INR stability, prescription accuracy, and monitoring frequency.
- To determine if the system improved adherence to departmental anticoagulation guidelines.
Main Methods:
- Retrospective case series comparing manual and computerized warfarin prescriptions.
- Analysis of 26 pediatric patients in a tertiary cardiology department.
- Evaluation of INR stability, number of INR checks, and dosage adjustments.
Main Results:
- Computerized system use maintained mean time in therapeutic range for INR (76% vs. 79%, p=0.79).
- Median INR checks per patient over 28 days remained consistent (1.9 vs. 2.1, p=0.58).
- Prescribing practices significantly improved adherence to departmental guidelines with the computerized system.
Conclusions:
- Computerized decision support for warfarin management is effective in pediatric anticoagulation.
- The system maintained INR stability without increasing monitoring or dosage adjustments.
- Implementation of such systems can enhance prescribing accuracy and guideline adherence in pediatric cardiology.
Objective:
To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation.
Design:
Retrospective case series study comparing manual and computerised records of prescribing.
Setting:
A tertiary paediatric cardiology department in a teaching hospital.
Participants:
The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making.
Interventions:
A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians.
Main Outcomes:
We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department.
Results:
We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines.
Conclusion:
The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.
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