A simple addition to a hospital’s electronic health record system can greatly improve discharge documentation of patients on warfarin and other blood thinners, according to a study performed at University of Missouri Health Care.
Post-discharge management of warfarin can be difficult because of medication nonadherence, dosing errors and other problems. Researchers at Missouri wanted to create an improved, electronic management process for such patients that would fit within its workflow after a transition from paper to electronic records. Its previous system, which involved paper forms and faxing, had become obsolete; moreover, the forms sometimes did not end up in the hands of providers and caused confusion since warfarin plans can change often.
“It was not uncommon for patients to fall through the cracks,” says Margaret Day, medical director at MU Health Care’s Family Medicine-Keene Clinic and one of the lead researchers of the study.
The researchers, with input from physicians, pharmacists and IT professionals, modified the EHR to create an outpatient warfarin management order as part of the patients’ discharge summary. The order includes five elements. The percentage of patients’ discharge information that contained all five of the key elements for warfarin management increased to 78 percent from 42 percent preintervention, a difference that is enough to reduce confusion about treatment and improve the sharing of the data with the patient’s post-discharge provider. Moreover, 61 percent of physicians and pharmacists surveyed said that the new was “user friendly and accessible,” says Day.
The study, published in the Joint Commission Journal on Quality and Patient Safety, notes several challenges, including how to communicate posthospital lab results to the posthospital provider and the ongoing need for education about the project throughout the organization.
The researchers have not yet reviewed whether the order has had an effect on patient outcomes. Day noted that this may be an area for follow up.
“The severe outcomes [of inadequate warfarin management], particularly among older patients is pretty striking. So a systemwide intervention that didn’t cost anything except some time and human resources might help make safety improvements and down the road cost improvements,” she says.
