Improving warfarin safety in long-term care.

Area of Science:

• Geriatric Pharmacy
• Pharmacoeconomics
• Patient Safety

Background:

• Anticoagulation management with warfarin requires careful monitoring, particularly during antibiotic co-prescription.
• Suboptimal anticoagulation control in long-term care facilities (LTCFs) can lead to adverse events.
• Existing quality improvement initiatives may face challenges in implementation within LTCFs.

Purpose of the Study:

• To evaluate the effectiveness of a multidisciplinary intervention aimed at improving warfarin safety in LTCFs.
• To assess the impact of the intervention on objective quality indicators of anticoagulation management.

Main Methods:

• A pre-post study design was employed over 12 months in twelve LTCFs in New York.
• Interventions included data reports, pharmacy alerts, quality improvement meetings, and Webinars.
• Primary outcome: timely International Normalized Ratio (INR) testing post-antibiotic initiation; secondary outcomes: time in therapeutic range (TTR), INR variability.

Main Results:

• At baseline, only 70% of warfarin-antibiotic co-prescribing events had timely INR testing; TTR was 45.49%.
• The intervention significantly improved timely INR testing to 79.6% (P=0.03).
• Secondary outcomes, including TTR and INR variability, showed no significant improvement; facility adherence was poor.

Conclusions:

• Despite a structured intervention, anticoagulation management in LTCFs remained suboptimal.
• LTCFs may struggle to voluntarily implement best practices for warfarin management.
• Regulatory and reimbursement system changes may be necessary to improve anticoagulation care in these settings.