Oral anticoagulation management in primary care nursing. The decision to start warfarin therapy requires an assessment of its harms and benefits for each patient. Decision support software cdss or by approved clinical guidelines example included appendix 1. This assessment should take into account the patients medical, social, dietary and drug history, level of education and adherence to previous therapy. Safe anticoagulant management for patients taking warfarin. Discharge arrangements for warfarin monitoring should be clearly.
How to manage warfarin therapy australian prescriber. A small proportion of patients 5% are warfarin resistant. At the bottom of the warfarin dosing calculator click on the stop warfarin button to open the stop warfarin popup. The national patient safety agency npsa has identified oral anticoagulants and heparin as major causes of adverse events and hospital admission. In palliative care the focus of care is on quality of life and the burdens and benefits of medications require consideration. There is no maximum dose of warfarin but most patients require 2mg to 10mg per day. Providers should normally use computer dosing software systems awmsg warfarin monitoring 11. The national patient safety agency npsa states that there is evidence that anticoagulant dosing software helps to maintain the inr levels within the. Guidance on the safe use of warfarin in primary care. Incorrect selection, preparation and administration of heparin products. Details of our current reporting and alerting functions can be found below.
Following the npsa alert st anns hospice undertook an audit to examine its practice. They also have an important function in auditing the anticoagulant service. Warfarin is therefore an intrinsically high risk drug requiring care to ensure that its prescription is appropriate and that anticoagulation is carefully monitored to minimise risk. These tools ensure you capture the most revenue for your practice and that you are protected with comprehensive treatment process workflow, records keeping and documentation. Mechanism of action warfarin, a coumarin derivative, inhibits clotting by limiting hepatic production of the biologically active vitamin kdependent clotting. Most effective and efficient in managing our warfarin patients gp, sheffield. Objective to assess the safety and efficacy of home international normalised ratio inr monitoring near point testing using the coaguchek machine with support and advice from the paediatric cardiac team and to assess variance from the national patient safety agency npsa alert 18 actions that can make anticoagulant therapy safer safety indicators. Appropriate reason for initiationcorrect dosage prescribedcoprescribed medicines are not contra indicatedappropriate bloodwork is performed. Guideline on oral anticoagulation with warfarin this guideline is intended to be used in derbyshire to support the primary care led inr monitoring service commissioned in derbyshire.
National portable storage association npsa is the leading trade association over 500 member companies for companies. Menzin j, boulanger l, hauch o, friedman m, marple c b, wygant g, hurley j s, pezzella s, kaatz s. According to its research, anticoagulants are implicated in 810 per cent of preventable drugrelated admissions 1,2 and are increasingly associated with adverse incidents, including some. Because of the software application, the amount of time required by the centralized clinician is minimized, with no loss of clinical effectiveness. The national patient safety agency npsa website has now been archived. Choice of computer dosing software such as dawn, rat or inr star should be agreed with the health board. Once stabilised the time between appointments can be increased, usually dictated by dosing software dawn, rat, inrstar the maximum recommended time between appointments is 12 weeks npsa check when a patients next appointment is. Unsafe arrangements and communications at discharge from hospital. Write a report to identify those patients doacs have the advantage of having a wider therapeutic window than warfarin and require lessfrequent monitoring and hospital visits. Oral anticoagulant warfarin guidelines oxford university hospitals. We recently launched a new reporting tool the gp eform, designed to make it. In the clinically effective anticoagulation management of patients receiving warfarin therapy. Npsa national patient safety agency npt near patient testing pe pulmonary embolus pmr patient medication record spc summary product characteristics qa quality assurance 5. The whole practice agrees it is excellent gp, fife.
Patients prescribed warfarin longterm should be assessed at least annually and have documentation of a gold standard annual. The national patient safety agency npsa recommendations state that key information about patients on warfarin. Warfarin is recommended for the prevention of systemic embolism, stroke associated with atrial fibrillation, and venous thromboembolism. Npsa network makes it easy to find a storage provider in your location. National patient safety agency npsa, nhs england and the medicines and healthcare products. Guideline on oral anticoagulation page 1 of 14 revised. Anticoagulant monitoring and dosing medical protection society.
The national patient safety agency npsa advises that compliance aids may be helpful, but that in their absence the risk of using warfarin may outweigh the benefits. Managing non warfarin patients non warfarin patients on inrstar. Joining npsa will give you access to information and resources to help you remain competitive and strong in a volatile business climate. Moving anticoagulation initiation and monitoring services. Home inr monitoring for paediatric congenital heart. The first audit was undertaken from february 2008august 2008. The outcome was to shift the initiation and monitoring service in secondary care for noncomplex patients, including domiciliary. Warfarin is the most common vka in clinical use today. Safe use of warfarin in primary care medicines governance team. For the second process, interpretation of the inr result and management of the result, the national patient safety agency npsa6 recommend the use of computerised decision support software cdss to determine the dose and recall for individual patients.
Management of anticoagulation in the perioperative period for major surgery. Warfarin management adult ambulatory clinical practice. Avoid all aspirin based medications and non steroidal antiinflammatory medications unless prescribed by your doctor and please tell whoever is monitoring your warfarin if you are taking these. The warfarin quality metrics npsa audit report shows the total calculated ttr for all patients at a location for the preceding 12 months. Decision support software cdss or by approved clinical guidelines. Background warfarin is being used in the management of increasing numbers of patients and conditions including patients postmyocardial infarction, atrial fibrillation, dvts and other disorders. Quality of anticoagulation control and costs of monitoring. These tools ensure you capture the most revenue for your practice and that you are protected with comprehensive treatment process workflow, records keeping and. The inr results, and any clinical alerts generated by their responses, are sent to the warfarin clinic through the automated portal. This page forms part of a resource on medication related patient safety alerts issued by the national patient safety agency npsa between 2002 and 2012 more details can be found here you will also find links to. Background in march 2007, npsa issued a safety alert regarding the oral anticoagulant warfarin. The national patient safety agency npsa, with support from the british dental. Impact of an inpatient anticoagulation monitoring program. The latter can be achieved through implementation and regular audit of the national patient safety agency npsa guidance on actions that make anticoagulants safer.
Self monitoring of coagulation status in adults and children on longterm warfarin therapy who have atrial fibrillation or heart valve disease is recommended as an option if the person prefers this form of testing and the person or their carer is both physically and cognitively able to self monitor. Doseresponse clinic helps you manage warfarin patients in multiple hospital clinic and physician office locations, each using a nurse or medical assistant at the specific patient care site. Dosing should not be increased by more than 520% weekly dose. Recommendations from the british committee for standards. National patient safety agency npsa, nhs england and the medicines and healthcare products regulatory agency mhra have also been taken into consideration. Using anticoagulation software and clinical judgement, their warfarin dose and date of next inr test is determined. Insufficient support and monitoring of warfarin therapy for the. Patients on non warfarin anticoagulants can be managed within inrstar. The dosing regime and date of next inr test is then entered into the portal by the member of staff. Selfmonitoring and selfmanagement of vitamin k antagonist treatment. Anticoagulation in the hospice setting bmj supportive. People who self monitor their inr levels use a portable inr monitor, as in a clinic, to take and test a drop of blood, drawn from a finger at scheduled times, and record the inr level measured by the.
Unconsidered coprescribing and monitoring of nsaids and other interacting medicines. Past npsa alerts and guidance remain available on the archived website but please use these materials with caution. The national patient safety agency npsa contacted the medical and pharmacy defence organisations as well as the nhs litigation authority and was informed that here have been 480 reported cases of harm or near harm from the use of anticoagulants in the uk from 19902002. October 2019 guideline on oral anticoagulation with warfarin this guideline is intended to be used in derbyshire to support the primary care led inr monitoring service commissioned in derbyshire, by the pct historically and now by the ccgs. The patient ttr band report displays the frequency distribution of the ttr results of individual patient ttrs at a location for the last 12 months. In the pages that follow we offer some practical tips on the art and science of using warfarin safely and effectively.
All your practice needs is a web browser and an internet connection. Log in to the warfarin monitoring application page 1. Archived npsa alert actions that can make oral anticoagulant therapy safer 2007 published 28th march 2007, updated 22nd august 2018 medicines use and safety team. Excellent software, must be the handiest piece of medical software anywhere gp, west glam. Anticoagulation monitoring 2016 17 a purpose of agreement. Warfarin therapy management province of british columbia. Dawn ac anticoagulation software dawn clinical software.
In 2007 the national patient safety agency npsa issued recommendations for. Initial warfarin dosing should be tailored based on patient bleed risk, potential sensitivity to warfarin, indication, goal inr range, and if potential drug interactions are present. Warfarin monitoring on initiation of warfarin patients may be seen daily. There is evidence that anticoagulant dosing software helps to. Warfarin quality metrics npsa audit report inrstar help. Pharmacists providing an anticoagulant monitoring service should be familiar with all of this guidance.
Warfarin therapy reduces the risk of thromboembolic events and has demonstrated effectiveness for the prevention of stroke in patients with atrial fibrillation af. Quality of anticoagulation control and costs of monitoring warfarin therapy among patients with atrial fibrillation in clinic settings. Learning from patient safety incidents nhs improvement. Guideline on the management of patient treated with oral. Doseresponse outpatient warfarin management software. Bleeding, particularly in the setting of overanticoagulation, is a major concern. Inr self monitoring is used by patients on longterm and on lifetime anticoagulation therapy to measure their inr international normalized ratio levels themselves, rather than at a clinic. Only accredited practitioners who meet the service specification and sign up to the service level agreement should provide this service. The national nhs patient safety team is now part of nhs improvement. Insufficient support and monitoring of warfarin therapy for the first 3 months and for vulnerable groups. Over 1,300 new warfarin patients requiring anticoagulation treatment added to the inrstar system to monitor ttr and regular patient monitoring which all reduce the risk of stroke.
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