The effects of interprofessional collaboration on nurse managed warfarin program
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Issue Date
2018-12
Authors
Braungart, Carol
Watson, Alexandra
Rubin, Rochel
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Abstract
Background: Warfarin is an effective, inexpensive therapy for thromboembolic prevention and treatment which requires oversight of the International Ratio (INR) to prevent injury due to clotting or bleeding. Guidelines suggest a Time in Therapeutic Range (TTR) of the INR should be above 65% in order to reduce risk of adverse event. Research was initiated to determine if nurses utilizing a standardized protocol within an Internal Medical practice could provide the same standard of care as the medical providers at the site.
Program design: Nurses (Licensed Practical and Registered Nurses) in an Internal Medicine Practice received competency based education regarding management of warfarin from an embedded clinical pharmacist. A retrospective analysis was performed on patients comparing TTR before and after the training protocol and conversion to nurse managed management was implemented.
Observations: Using the Rosendaal method, the mean baseline TTR from July 1, 2015–June 30, 2016 was 69.6%. Following 12 months of the pharmacist-nurse collaboration for warfarin monitoring, the mean TTR from July 1, 2016–June 30, 2017 was 68.4%.
Findings: There was no significant difference in TTR in the provider managed or nurse managed cohort suggesting the quality of patient management and maintenance of TTR is maintained. While the study did not show improvement of TTR by the nursing staff, quality of care was maintained and interprofessional collaboration was created. Future implications of the study include identifying the patients who are candidates to switch to a novel agent and build on established interprofessional relationships to further patient safety and efficacy
Citation
Braungart, Carol, et al. “The Effects of Interprofessional Collaboration on Nurse Managed Warfarin Program.” Journal of Interprofessional Education & Practice, vol. 13, Dec. 2018, pp. 56–58., https://doi.org/10.1016/j.xjep.2018.09.003.
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