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Improving inpatient warfarin therapy safety using a pharmacist-managed protocol.

Paul R Daniels1, Dennis M Manning2, James P Moriarty3

  • 1Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

BMJ Open Quality
|May 2, 2018
PubMed
Summary

A pharmacist-managed warfarin protocol (PMWP) improved international normalized ratio (INR) control in hospitalized patients. This warfarin management strategy reduced excessive INR levels and near-term bleeding, particularly in surgical patients.

Keywords:
hospital medicinemedication safetypatient safetypharmacistsquality improvement

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Patient Safety

Background:

  • Inpatient warfarin management presents significant safety challenges.
  • A need existed to optimize warfarin dosing and monitoring for hospitalized patients.

Purpose of the Study:

  • To evaluate the impact of a pharmacist-managed warfarin protocol (PMWP) on inpatient warfarin safety.
  • To assess improvements in international normalized ratio (INR) control and complication rates.

Main Methods:

  • A multidisciplinary team developed and implemented an 'opt-out' pharmacist-managed warfarin protocol (PMWP).
  • Warfarin dosing was guided by computer algorithms, with pharmacists managing the protocol.
  • Interrupted time series analysis compared outcomes before and after implementation.

Main Results:

  • The PMWP was adopted for most surgical and non-surgical inpatients.
  • The frequency of INR > 5 decreased significantly in both medical and surgical patients.
  • Postoperative bleeding rates decreased among surgical patients.

Conclusions:

  • The pharmacist-managed warfarin protocol (PMWP) successfully improved INR control for inpatients.
  • The PMWP led to a reduction in near-term bleeding complications, especially in higher-risk surgical patients.