Development of a Proactive Warfarin Safety Monitoring and Management System
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Abstract
Objective: To develop a proactive warfarin safety monitoring and management system and evaluate its outcomes. Methods: This action research employed three cycles of the Plan–Act–Observe–Reflect (PAOR) model to develop a patient care system for warfarin users at Sisaket Hospital from October 2023 to December 2024. Evaluation outcomes included medication errors, the proportion of patients with INR values within the therapeutic range, staff knowledge and satisfaction toward the system, and patient adherence. Results: The developed proactive safety monitoring and management system comprised seven key components: 1) a warfarin patient care guideline, 2) formulation of a vitamin K solution, 3) capacity building for healthcare personnel, 4) incorporation of medication error indicators into departmental KPIs, 5) referral linkage to primary care for integrated management, 6) establishment of a Line Official Account for patient follow-up, and 7) expansion of warfarin clinic service points. Comparison between pre- and post-system implementation showed a reduction in the incidence of severe adverse events requiring hospitalization from 2.12% to 0.98%. The proportion of patients with INR within the target range significantly increased (P < 0.001) from 44.30% before to 63.14% after system development. Percentage of time within the therapeutic INR range improved from 54.85% to 58.70%. Proactive follow-up records were utilized in 82.47% of patients with INR ≥ 5, meeting the target. Patient with adequate adherence increased significantly (P < 0.001) from 45.23% before system development to 63.95% after. Average staff satisfaction with the developed system was 4.78±0.42 out of 5 points. Conclusion: The developed system enhanced warfarin use safety by increasing the proportion of patients achieving target INR and reducing severe complications. Continuous review of practice adherence to the established guidelines is recommended for sustainable improvement.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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