Development of a Care Process at Sub-district Health Promotion Hospitals in Kamalasai Health District to Enhance Safety for Warfarin Patients
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Abstract
Patients using warfarin should administer this medication carefully to prevent adverse drug reactions. However, it was recently revealed that at a sub-district health promoting hospital (SHPH) in the Kamalasai District Health Network patients were frequently prescribed medicines that could potentially interact with warfarin. Therefore, it is necessary to develop a care process for patients using warfarin in order to improve safety for these patients when they visit SHPHs. Materials and Methods: This action research study, conducted in the Kamalasai District Health Network, was divided into four steps: planning, action, observing, and reflecting. The ‘planning’ step involved collecting data from various stakeholders to establish a care process for SHPHs. Participants included fifteen patients using warfarin, ten prescribers at the SHPH, and five health staff members at the Kamalasai Hospital warfarin clinic. The ‘action’ step involved the official implementation of an agreement regarding the care process for all SHPHs within the health network. The ‘observing’ step involved quantitative data collection comparing pre- vs. post-study incidence of prescribing drugs that potentially interact with warfarin, and a pre-/post-assessment of a participant’s knowledge of the safe use of warfarin. In the ‘reflecting step’ all participants shared their opinions on the modified care process. Participants also documented changes in their knowledge, awareness, and practices when prescribing medication to warfarin patients. Results: The care process included multiple components such as the use of alerting tools, guidelines for medicine use, protocols for referring patients experiencing complications, and continuous contact between researcher and SHPH prescribers to ensure adherence to care protocol. Quantitative analysis indicated a trend toward decreased frequency of inappropriate prescription of potential warfarin-interacting drugs, from 1.6% to 1.4%, but this was not statistically significant (p = 0.906). Enhancement of the education of SHPH prescribers regarding warfarin (n = 36) did significantly increase from 7.9 ± 0.8 to 9.9 ± 0.9 (p < 0.001; maximal score = 11). Reflection revealed that participants had more confidence in patient care and an elevated awareness concerning the safety of multi-drug administration to patients using warfarin. Conclusion: A modified process for providing care at SHPHs for patients using warfarin did not significantly reduce the frequency with which drugs were prescribed that could adversely interact with warfarin. However, providing SHPH prescribers with a better understanding of the concerns regarding the use of warfarin is expected to increase safety for patients taking warfarin.
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References
Arayawongchai D, Kaothean T, Siriangkhawut M, Promsupan S. The result of implementing network of care for post operative valvular heart patients who use warfarin. J of Health Sys Res 2007; 6(1): 125-33.
Barnes GD, Acosta J, Christopher MPH, et al. Barriers to integrating direct oral anticoagulants into anticoagulation clinic care : A mixed methods study. Res Pract Thromb Haemost 2019; 3: 79–84.
Biawbanjong S. The clinical outcome of pharmaceutical care on warfarin in out-patients at Chiangrai regional hospital. [Thesis]. Chiang Mai: Chiang Mai University; 2000.
Cardiovascular Health Service Development Committee. Action plan for development of cardiovascular health services subject warfarin clinic management. Nonthaburi; 2016.
Choompon C, Sunghlor S, Khonglormyati J. Development of warfarin safety monitoring network in Phra Nakhon Si Ayutthaya Province. J of Health Science 2014; 23: 445-52.
Dechkalaya A. Effectiveness of warfarin –drug interaction program for prevention of adverse drug event at out-patient department royal irrigation hospital, Nonthaburi Province. [Thesis]. Nakhonpathom: Silpakorn University; 2012.
Dreischulte T, Guthrie B. High-risk prescribing and monitoring in primary care how common is it, and how can it be improved. Ther Adv Drug Saf 2012; 3(4): 175–84.
Joyner K, Mash B. A comprehensive model for intimate partner violence in South African primary care action research. BMC Health Serv Res 2012; 12: 399.
Knijff-duatmer EAJ, Schut GA, Van De Laar MA. Concomitant coumarin-NSAID therapy and risk for bleeding. Ann Pharmacother. 2003; 37: 12-6.
Lertsinudom S, Chumworathayi P, Chaiyakum A. Drug use review of warfarin in medicine ward, Srinagarind Hospital. Srinagarind Med J. 2010; 25(1): 6-13.
Pasunon P. Reliability of Questionnaire in Quantitative Research. Parichart J 2014; 27(1): 144-63.
Rainu K, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision Support systems on medication safety. Am Med Assoc 2007; 5: 109–21.
Rose AE, Robinson EN, Premo JA, et al. Improving warfarin management within the medical home: a health-system approach. Am J Med 2016; 130(3) : 365.e7-365.e12.
Sørensen EW, Haugbølle LS. Using an action research process in pharmacy practice research A cooperative project between university and internship pharmacies. Res Soc Adm Pharm 2008; 4(4); 384–401.
Sriboonchue P, Carmirael P, Soontranchun T, Prisuwan A. Warfarin use guideline for pharmacists: Experience of Central Chest Institute of Thailand. Nonthaburi; 2010.
Strategy and Planning Division, Ministry of Public Health. A handbook of developing quality health promotion hospital. Nonthaburi; 2018.
Strom BL, Schinnar R, Aberra F, et al. Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction. Am Med Assoc 2010; 170(17): 1578-1583
Sukanantachai B, Sapoo U, Supsinwiwat A, et al. Implementation and outcome evaluation of satellite network of Anticoagulation clinics in Nakornratchasima province, Thailand. J of Health Science 2011; 5: 495–504.
Tamblyn R, Huang A, Perreault R, et al. The medical office of the 21st century (MOXXI): Effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ 2003; 169(6): 549–56.
Tatro DS. Drug interaction Facts. 2015. Missouri: Wolters Kluwer Health.
The Heart Association of Thailand under the Royal Patronage of H.M. the King. Oral anticoagulant treatment guideline. Available from: https://www.thaiheart.org/index.php?lay=show&ac=article&Id=539252670&Ntype=5 [Accessed 16th March 2019].
Wangsook P, Kittiboonyakun P, Sookaneknun P. Evaluation of multidisciplinary health care program for patients using warfarin at health promotion sub-district hospitals. Thai J Pharm Pract 2014; 6: 92-105.
Wangsuk P, Sangyoi S. Development of a network for care of patients on warfarin among health promoting hospitals. Journal of Health Science 2014; 23: 45-51.
Zhang K, Young C, Berger J. Administrative claims analysis of the relationship between warfarin use and risk of hemorrhage including drug-drug and drug-disease interactions. J Managed Care Pharm. 2006; 12: 640-8.