Adverse effects of warfarin
accounted for 33% of annual emergency hospitalizations for
patients 65 or older in the United States.
Warfarin is a commonly prescribed blood thinner used to prevent
harmful blood clots. However, the drug requires frequent monitoring,
daily dosing and can result in serious negative effects when mixed with
vitamin K, a vitamin commonly found in vegetables such as lettuce or
‘Using electronic health records (EHR) can improve the care patients on warfarin receive after they leave the hospital and eliminate potential confusion among care providers and pharmacists.’
Now, a new study from University of Missouri Health Care has
found that using electronic health records (EHR) can improve the care
patients receive after they leave the hospital and eliminate potential
confusion among care providers and pharmacists.
Margaret Day, a
primary care physician and medical director at MU Health Care's Family
Medicine-Keene Clinic, said, "At MU Health Care, we designed the 'Outpatient
Warfarin Management Order' record in response to The Joint Commission's
call for institutions to reduce possible patient harm associated with
the use of warfarin."
Day said that before the intervention, physicians would give
patients warfarin management plans on paper forms, which made it
difficult for providers to later obtain that information later. Paper
forms also sometimes caused confusion among pharmacists, physicians and
patients since the warfarin plans could change frequently, according to
MU Health Care currently uses an EHR that generates a comprehensive
health summary for each admitted patient. Day said that her team found
the discharge summary to be a valuable tool to communicate the key
elements needed for patients and health providers to manage warfarin
"The information entered is visible to the patients and their
community health care providers," Day said. "In addition, the record
also coordinates communication to pharmacy services for any dosage
Before implementing the new record, Day's team found that 42%
of patients' discharge charts included key elements for discharging
patients on warfarin. After the intervention, the team found that
percentage nearly doubled, to 78%. In addition, physicians and
pharmacists who used the new record were surveyed.
"Of the 28 physicians and pharmacists who took part in the survey,
61% said that the new warfarin order was 'user friendly and
accessible,'" Day said.
Day said that this study demonstrates the EHR's potential value in
assisting with warfarin or anti coagulation therapy between outpatient
and inpatient settings and across multiple providers. In addition, Day
said the new process not only provides notification about the transition
care to patients' referring health providers in their communities, but
also facilitates collaborative care with pharmacies.
The project, "Improving Transitions of Care for Hospitalized Patients on Warfarin," was published in The Joint Commission Journal on Quality and Patient Safety