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Improving warfarin safety in long-term care.

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Summary

A warfarin safety intervention in long-term care facilities improved timely International Normalized Ratio (INR) testing but did not enhance other quality measures. Poor adherence limited the intervention's overall impact on anticoagulation management.

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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.