Anticoagulation education: do patients understand potential medication-related emergencies?
BACKGROUND
The Joint Commission Venous Thromboembolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats.


METHODS
From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants.


RESULTS
For the 184 patients (38% completion rate), the mean knowledge score was 69% (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59% (95% confidence interval [CI], 57.3%-60.3%). Respondents overestimated non-urgent-severity situations 23% of the time (95% CI, 20.8%-24.7%), while underestimating urgent-severity situations 21% of the time (95% CI, 19.0%-23.9%). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement.


CONCLUSIONS
Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.
University of California, Davis, CA, USA. morelandc3@uthscsa.edu
Christopher J
CJ
Moreland
Richard L
RL
Kravitz
Debora A
DA
Paterniti
Chin-Shang
CS
Li
Tzu-Chun
TC
Lin
Richard H
RH
White
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D004630:Emergencies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D061214:Patient Safety; D010361:Patients; D010593:Pharmaceutical Services; D012307:Risk Factors; D012959:Socioeconomic Factors; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin