title: Randomized trial of a warfarin communication protocol for nursing homes: an SBAR-based approach.
abstract: BACKGROUND
  More than 1.6 million Americans currently reside in nursing homes. As many as 12% of them receive long-term anticoagulant therapy with warfarin. Prior research has demonstrated compelling evidence of safety problems with warfarin therapy in this setting, often associated with suboptimal communication between nursing home staff and prescribing physicians.
  
  
  METHODS
  We conducted a randomized trial of a warfarin management protocol using facilitated telephone communication between nurses and physicians in 26 nursing homes in Connecticut in 2007-2008. Intervention facilities received a warfarin management communication protocol using the approach "Situation, Background, Assessment, and Recommendation" (SBAR). The protocol included an SBAR template to standardize telephone communication about residents on warfarin by requiring information about the situation triggering the call, the background, the nurse's assessment, and recommendations.
  
  
  RESULTS
  There were 435 residents who received warfarin therapy during the study period for 55,167 resident days in the intervention homes and 53,601 in control homes. In intervention homes, residents' international normalized ratio (INR) values were in the therapeutic range a statistically significant 4.50% more time than in control homes (95% confidence interval [CI], 0.31%-8.69%). There was no difference in obtaining a follow-up INR within 3 days after an INR value ≥4.5 (odds ratio 1.02; 95% CI, 0.44-2.4). Rates of preventable adverse warfarin-related events were lower in intervention homes, although this result was not statistically significant: the incident rate ratio for any preventable adverse warfarin-related event was .87 (95% CI, .54-1.4).
  
  
  CONCLUSIONS
  Facilitated telephone communication between nurses and physicians using the SBAR approach modestly improves the quality of warfarin management for nursing home residents.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan, Fallon Clinic, Worcester, USA. terry.field@umassmed.edu
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Mazor
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Donovan
authors.forename: Abir O
authors.initials: AO
authors.lastname: Kanaan
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Harrold
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Peter
authors.initials: P
authors.lastname: Doherty
authors.forename: Ann
authors.initials: A
authors.lastname: Spenard
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols; D003142:Communication; D003237:Connecticut; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards; D009740:Nursing Staff; D011785:Quality Assurance, Health Care; D013689:Telephone; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin