Implementation of an order set to adhere to national patient safety goals for warfarin therapy

Area of Science:

• Clinical Pharmacy
• Patient Safety
• Pharmacoeconomics

Background:

• The Joint Commission mandated National Patient Safety Goal (NPSG) 03.05.01 in 2009 to mitigate risks associated with anticoagulant therapy.
• Patient harm from anticoagulant medications necessitates strict adherence to safety protocols.

Purpose of the Study:

• To evaluate the impact of a warfarin order set on adherence to laboratory monitoring and patient safety protocols.
• To assess improvements in patient education and discharge planning for warfarin patients.

Main Methods:

• A retrospective chart review was performed on 707 inpatients receiving warfarin.
• Data were collected pre and post the implementation of a warfarin order set between January 2008 and July 2011.
• Primary endpoint: overall adherence to laboratory monitoring; Secondary endpoints: compliance with individual parameters, patient education, and follow-up arrangements.

Main Results:

• Overall adherence to laboratory monitoring significantly increased from 71.8% to 87.5% (OR, 2.76; P < .001).
• Improvements were also observed in patient education completion prior to discharge.
• Appropriate follow-up arrangements documented at discharge also showed positive trends.

Conclusions:

• Implementation of a warfarin order set enhances adherence to policies and procedures for NPSG 03.05.01.
• Pharmacy-led monitoring, education, and follow-up arrangements contribute to successful patient safety parameter completion.