Point of Care Blog

Part 3 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines

In my view, one of the most important ways to achieve optimum warfarin control is the use of an anticoagulation, electronic clinical decision support tool that incorporates a validated warfarin dosing nomogram.  We’ve also learned in the last 20 years how we can really move the needle with respect to improving the quality of care for patients on NOACs.  Managing patients on NOACs is also a critical component of anticoagulation electronic decision support.

Part 1: Adverse Drug Events Related to Anticoagulation/VKA 

Coumadin (warfarin) is a tough sell.  As someone who has directed some of the largest Coumadin clinics in the country over the last 20 years, it is true that Coumadin is a drug that is impossible to dose, tough to monitor, causes death when used properly, and then lifesaving, when it’s not trying to kill you. 

It shouldn’t be surprising that warfarin is the number one cause of adverse drug-related events in older Americans requiring hospitalization.  In a fairly recent study (New England Journal of Medicine, 2011; 365:2002-12), adverse drug events (ADE’s) associated with warfarin occurred more often than oral antiplatelet agents, oral hypoglycemic agents, opioid analgesics, Digoxin as well as other high-risk drugs.

In Part 1, we discussed the focused information clinicians need to quickly assess an anticoagulation patient’s health and a review of patient treatment plan trends.  Here in part 2, we will discuss the many ways to identify patients who are at risk for drug interactions or re-admissions, and evidence-based guidelines that support dosing decisions.

 Identify Patients at Risk

There are many ways to identify patients that require a bit of extra scrutiny.  PCDS believes it is important that a clinician is immediately made aware of any patients with higher than normal levels of risk given their care plan.  We further believe it is important that risk identifiers be objective and measurable.  That is why AC has three validated survey instruments built into the application for easy access, execution as well as to clearly demonstrate the results of completed surveys when they indicate patients may be at risk.