Development of a dosing algorithm in a nurse‐managed outpatient anticoagulation clinic

Abstract

Purpose: To compare the effectiveness of an algorithm created for use in a nurse‐managed outpatient anticoagulation clinic with the use of clinical judgment without formalized guidelines. Data source: A search of the databases in Pub Med and the Cumulative Index to Nursing of articles published through November 2009 yielded 19 articles concerning warfarin, practice guidelines, and use of algorithms. Methods: A retrospective study was conducted comparing 179 consecutive patient visits in September 2007 with 206 consecutive patient visits in 2009 at the Johns Hopkins Outpatient Anticoagulation Clinic. An algorithm was created that incorporated “removeable causes” to aid nurses in decision making when, for example, additions and deletions of new medications are added that interact with warfarin (Coumadin). Results: In both years, there was a greater percentage of no change versus change in warfarin dose reflecting stable dosage patterns in both years. Chi‐square analysis showed no statistical significance in the relationship between dosing changes and year. A significant relationship was found, however, between removeable causes and year, suggesting improved documentation of removable causes in 2009. Implications for practice: Further study with a larger prospective randomized sample population is needed to more accurately assess the algorithm's effect on time in therapeutic range (TTR).

Factors Affecting the Quality of Anticoagulation With Vitamin K Antagonists in Venous Thromboembolism Patients

“…Achieving the appropriate quality of anticoagulation has been a challenge for health professionals, including nurses, for many years. Their work has been indispensable in educating patients, reducing adverse events, and achieving greater TTR (Akl et al, 2014; Francavilla, 2008; Hefter & Stack, 2011; Oterhals et al, 2014; Palareti et al, 2005; Pattacini, Manotti, Pini, Quintavalla, & Dettori, 1994; Sawicka-Powierza, Oltarzewska, Chlabicz, Rogowska-Szadkowska, & Marcinowicz, 2009). However, previous work has primarily explored the quality of anticoagulation in AF patients, while in patients with VTE, it has scarcely been investigated.…”

Effectiveness and Health Outcomes of Collaborative Nurse Prescribing for Patients Anticoagulated with Antivitamin K in Primary Care: A Study Protocol

“…This was undertaken using a retrospective study that compared 179 patient visits in September 2007 with 206 in 2009 at the Johns Hopkins Outpatient Anticoagulation Clinic. An algorithm that incorporated "removable causes" was created to help nurses in their decision making, for instance, when adding and removing new medication that interacts with Warfarin [15]. There were higher percentages of an absence of changes versus changes in warfarin dosages, which reflect stable dosing patterns in both years.…”