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Related Experiment Videos

An evaluation and improvement program for inpatient anticoagulant control

W S Phillips1, J Smith, M Greaves

  • 1Department of Cardiology, Royal Hallamshire Hospital, Sheffield, UK.

Thrombosis and Haemostasis
|February 1, 1997
PubMed
Summary

New charts improved anticoagulant drug management for inpatients. Heparin control improved significantly, and over-anticoagulation with warfarin was halved, enhancing patient safety.

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Health Informatics

Background:

  • Inpatient anticoagulant therapy requires careful management to prevent bleeding and clotting events.
  • Existing methods for prescribing and monitoring heparin and warfarin may lead to suboptimal therapeutic control.

Purpose of the Study:

  • To evaluate the impact of introducing combined prescription and monitoring charts with integrated clinical guidelines on anticoagulant control in hospitalized patients.
  • To assess improvements in adherence to guidelines and the quality of anticoagulant prescribing and monitoring.

Main Methods:

  • Implementation of integrated heparin and warfarin charts with clinical guidelines in a 700-bed acute teaching hospital.
  • Utilized a custom-written computer program to assess anticoagulant control, measuring time spent within, below, and above therapeutic ranges.

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  • Pre- and post-intervention data analysis to determine changes in anticoagulant control metrics.

    • Main Results:

    • Significant reduction in the percentage of time patients were under-anticoagulated with heparin (activated partial thromboplastin time ratio < 1.5), falling from 32.7% to 18.5% (p < 0.0001).
    • No significant change in the percentage of time patients were over-anticoagulated with heparin.
    • Significant reduction in the percentage of time patients were over-anticoagulated with warfarin (International Normalised Ratio > 4.5), halved from 5.4% to 2.7% (p < 0.001).
    • Percentage of time under-anticoagulated with warfarin remained unchanged.

    Conclusions:

    • The introduction of combined prescription and monitoring charts significantly improved the quality of anticoagulant control for inpatients.
    • The intervention enhanced adherence to clinical guidelines and improved the overall quality of anticoagulant management.
    • These integrated charts represent an effective strategy for optimizing anticoagulant therapy in acute care settings.