title: Management of oral anticoagulation in a population of children with cardiac disease using a computerised system to support decision-making.
abstract: OBJECTIVE
  To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation.
  
  
  METHODS
  Retrospective case series study comparing manual and computerised records of prescribing.
  
  
  METHODS
  A tertiary paediatric cardiology department in a teaching hospital.
  
  
  METHODS
  The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making.
  
  
  METHODS
  A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians.
  
  
  RESULTS
  We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department.
  
  
  RESULTS
  We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines.
  
  
  CONCLUSIONS
  The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.
authors.affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Juliet
authors.initials: J
authors.lastname: Soper
authors.forename: George T C
authors.initials: GT
authors.lastname: Chan
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Skinner
authors.forename: Heather D
authors.initials: HD
authors.lastname: Spinetto
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gentles
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003658:Decision Making, Computer-Assisted; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin