A baseline study of anticoagulant management in UK hospitals.
OBJECTIVE
To undertake a baseline study of the management of anticoagulants in order to allow later comparison of the impact of the National Patient Safety Agency (NPSA) patient safety alert (including a new patient held record) published in April 2007.


METHODS
A multimethod study comprising semistructured interviews in 20 acute trusts and a telephone/email survey of general practitioners (GPs).


RESULTS
The authors found a high degree of consensus concerning a number of problems in the management of anticoagulation services. Consultant haematologists and chief pharmacists expressed concern about the level of competence of junior medical and nursing staff and the quality of patient discharge from general inpatient wards. Patients were regularly discharged before being stabilised on Warfarin, pre-discharge information was not always given, patient-held records were not reliably completed nor follow-up arrangements made. At the ward level, there was some confusion about the responsibility for completing the yellow book on discharge and little awareness of the role of GPs in providing a monitoring service. GPs were largely dissatisfied with the quality of discharge information.


CONCLUSIONS
The baseline data present a significant cause for concern in the management of warfarin prior to the publication of the NPSA safety alert.
Lankshear
Annette
A
Cardiff School of Nursing and Midwifery Studies, Caerleon Campus, St Cadocs Hospital, Caerleon NP18 3XR, UK. lankshearaj@cardiff.ac.uk
Harden
Jane
J
Lowson
Karin
K
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002983:Clinical Competence; D032921:Consensus; D003625:Data Collection; D058005:General Practitioners / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D050316:Medical Order Entry Systems; D009313:National Health Programs; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D017751:Safety Management; D020521:Stroke / Q000517:prevention & control; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin