title: Evaluation of education on the appropriate use of vitamin k in warfarin reversal in adult inpatients.
abstract: OBJECTIVE
  Vitamin K (phytonadione) is a commonly used first-line reversal agent for vitamin K antagonist (VKA) therapy in patients presenting with a supratherapeutic international normalized ratio (INR) with or without significant bleeding or in patients with a therapeutic INR in need of surgery. The purpose of this study was to determine the impact of education on the appropriate use of vitamin K for VKA reversal.
  
  
  METHODS
  Data were collected on patients admitted to a community teaching hospital during February 2010 (pre-education group). These data were analyzed to determine the most common guideline deviations in vitamin K use. Following this analysis, pharmacist education took place in the form of in-service presentations; a protocol, including a guideline-based dosing table, was developed to assist pharmacists in evaluating vitamin K therapy. Data were then collected on patients admitted during February 2011 (post-education group).
  
  
  RESULTS
  Forty patients and 47 vitamin K administrations were included in the pre-education group, and 34 patients and 49 vitamin K administrations were included in the post-education group. The number of patients with appropriate vitamin K administrations improved after pharmacist education (25% pre-education vs 55.8% post-education; P = .01). Whereas 27.6% of individual vitamin K administrations were appropriate in the pre-education group, this increased to 63.2% in the post-education group (P = .04).
  
  
  CONCLUSIONS
  Education techniques on the appropriate use of vitamin K for VKA reversal significantly improved compliance with standards of care for proper use of vitamin K. Additional education sessions are necessary to further increase compliance with standards of care and subsequently optimize patient care.
authors.affiliation: Emergency Medicine Specialist, Methodist University Hospital, Memphis, Tennessee;
authors.forename: Megan A
authors.initials: MA
authors.lastname: Van Berkel
authors.affiliation: Assistant Professor of Pharmacy Practice, St. Louis College of Pharmacy/Mercy Hospital, St. Louis, Missouri;
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Crannage
authors.affiliation: Clinical Associate Professor, University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio. Corresponding author: Andrew J. Crannage, PharmD, BCPS, St. Louis College of Pharmacy/Mercy Hospital St. Louis, 4588 Parkview Place, St. Louis, MO 63110; phone: 314-446-8533; fax: 314-446-8500; e-mail: acrannage@stlcop.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Murphy
keywords: anticoagulation; anticoagulation reversal; phytonadione; vitamin K, warfarin