Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: a multidisciplinary practice improvement project.
BACKGROUND
Warfarin is a very complex, high risk therapy and one that carries the potential for severe adverse events. The aim of this project was to improve warfarin management through the application of the best available evidence. The project was undertaken in a 250 bed acute care metropolitan private hospital.


METHODS
A suite of evidence-based interventions were used including audit and feedback, patient and provider education, and decision support aides.


METHODS
This project used the ongoing collection of warfarin process and outcome clinical indicator data to measure improvement.


RESULTS
Compliance with loading protocol increased by 12% (42-54%); patient education prior to discharge increased by 54% (31-85%); INRs > 5 decreased by 2.6% (3.7-1.1%); and abnormal bleeds fell by 1.2% (1.2-0%).


CONCLUSIONS
This multifaceted suite of interventions was successful in influencing clinician behaviour and improving compliance with evidence-based warfarin guidelines.
Duff
Jed
J
Clinical Research Fellow, St Vincent's Private Hospital, Nursing Research Institute, St Vincent's & Mater Health Sydney, Australian Catholic University, Sydney, NSW, Australia.
Walker
Kim
K
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D054869:Clinical Audit; D003661:Decision Support Techniques; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D016304:Hospitals, Private; D006786:Hospitals, Urban; D006801:Humans; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D010564:Personnel, Hospital / Q000193:education; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin