title: Nurses' self-reported time estimation of anticoagulation therapy: a survey of warfarin management in long-term care.
abstract: BACKGROUND
  A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents.
  
  
  METHODS
  Forty LTC nurses validated the questionnaire to determine what protocols/procedures are involved in warfarin management. Twenty LTC nurses completed the survey, quantifying the time they spend on procedures related to warfarin management, and how often they performed each procedure for each resident each week.
  
  
  RESULTS
  The nurses reported that 26% of their residents were receiving warfarin; the majority (approximately 75%) of these residents began warfarin after admission to the facility. On average, the nurses spent 4.6 hours per week for treatment procedures and monitoring patients initiating warfarin therapy and 2.35 hours per week for each resident who was stable on warfarin therapy on admission. Overall, to care for an average number of newly initiated and stable warfarin patients in a medium-size LTC facility, staff nurses are estimated to spend 68 hours per week. Study limitations include the potential for bias because of the small sample size, representativeness of the sample, and the possibility of inaccuracies in respondents' self-reported time estimation of warfarin-related procedures.
  
  
  CONCLUSIONS
  In the context of a well-documented and expanding nursing shortage in the United States, the substantial use of time and resources necessary to initiate, monitor, and manage warfarin treatment in elderly LTC patients is of concern. Until the problem of understaffing is resolved, implementation of therapies that are simpler and require less nursing time-e.g. the use of new oral anticoagulants in the place of warfarin-may be a way to free up nursing time for other essential care tasks.
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ 08869 USA.
authors.forename: Aarti A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Janssen Scientific Affairs, LLC, 1000 Route 202, Raritan, NJ 08869 USA.
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Nelson
keywords: Anticoagulants; Long-term care; Monitoring; Nursing shortage; Quality of care; Warfarin management