Key result
Pharmacist-assisted electronic warfarin charting and monitoring reduced the percentage of patients with one or more warfarin errors from 27.7% to 7.4% (p < 0.01).
Why the study?
To evaluate whether proactive pharmacist-assisted electronic warfarin charting and monitoring reduces warfarin-related errors and improves the post-discharge continuum of care.
Does pharmacist-assisted electronic warfarin charting and monitoring reduce warfarin-related errors in hospitalized patients prescribed warfarin?
Observational (n=238)
Does pharmacist-assisted electronic warfarin charting and monitoring reduce warfarin-related errors in hospitalized patients prescribed warfarin?
Absolute Event Rate: 7.4% vs 27.7%
p-value: p=< 0.01
Proactive pharmacist-assisted electronic warfarin charting significantly reduces warfarin-related errors during hospitalization and improves the completeness of post-discharge communication.
Supports pharmacist-assisted electronic warfarin systems to cut inpatient errors; extends observational data but leaves open need for RCTs.
Aim To evaluate whether pharmacist‐assisted electronic warfarin charting and monitoring reduces warfarin‐related errors and improves post‐discharge continuum of care. Method Cardiology and medical patients admitted for at least 24 h and prescribed at least one warfarin dose were included in a pre/post‐intervention study. The intervention involved pharmacists proactively charting warfarin and ordering international normalised ratios (INRs) using electronic prescribing software, following discussion with medical doctors. Endpoints included: percentage of patients with one or more warfarin errors, INR > 5.0 during admission, readmission within 30 days for anticoagulant‐related issues and warfarin discharge plan (WDP) completeness (including documentation of next dose/s, and when and where the next INR was to be checked). Results Pre‐ and post‐intervention groups comprised 130 and 108 patients, respectively. Post‐intervention, more patients received warfarin following heart valve replacement and fewer for venous thromboembolism. Post‐intervention, pharmacists ordered 130 doses (72 patients) and 98 INRs (59 patients). Percentage of patients with one or more warfarin errors declined from 27.7 to 7.4% (p < 0.01), with INR> 5.0 decreased from 7.7 to 2.8% (p = 0.17) and readmission within 30 days for anticoagulation problems occurred in 4 and 0 cases pre‐ and post‐intervention, respectively. While there was a non‐significant decline in the proportion of patients with a WDP post‐intervention, when patients had a WDP it was more comprehensively completed (p < 0.01). Conclusion Pharmacists proactively charting and monitoring warfarin reduced warfarin‐related errors during hospitalisation and improved elements of post‐discharge communication. Closer multi‐disciplinary communication and 7‐day pharmacy services may result in further continuum of care improvements.
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Tyedin et al. (2020) conducted an observational in Warfarin management in hospitalized patients (n=238). Pharmacist-assisted electronic warfarin charting and monitoring vs. Pre-intervention standard care was evaluated on Percentage of patients with one or more warfarin errors (p=< 0.01). Pharmacist-assisted electronic warfarin charting and monitoring reduced the percentage of patients with one or more warfarin errors from 27.7% to 7.4% (p < 0.01).
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