Use of specific indicators to detect warfarin-related adverse events

Hartis, Charles; Gum, Michael O.; Lederer, James W.

doi:10.2146/ajhp040404

Cited by 17 publications

(11 citation statements)

References 16 publications

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“…Such prospective surveillance systems can alert the clinical team of impending or ongoing harm, thus allowing early intervention to limit harm. Real-time alerts were present within methods for detecting adverse drug events,11 21 23 26 35 45 general adverse events40 and nosocomial infection 14. Automated alerts were a component of the Health Evaluation through Logical Processing system11 14 and were incorporated within methods using automated lab signal detection,23 26 45 computer algorithms21 and other automated triggers 35 40…”

Section: Discussionmentioning

confidence: 99%

Automated detection of harm in healthcare with information technology: a systematic review

Govindan

Citters

Nelson

et al. 2010

BMJ Quality & Safety

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Section: Discussionmentioning

confidence: 99%

Automated detection of harm in healthcare with information technology: a systematic review

Govindan

Citters

Nelson

et al. 2010

BMJ Quality & Safety

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“…Although some experts believe that INRs should be monitored daily in hospitalized patients, this does not appear to be uniformly accepted. In some reports, 2 or 3 consecutive days without the performance of an INR was required to activate a reminder. Protocols from some major teaching hospitals specify intermittent monitoring once the INR is therapeutic .…”

Section: Discussionmentioning

confidence: 99%

“…Although many hospitals employ protocols that suggest daily INR monitoring until stable, there are no evidence‐based guidelines to support this practice . Conversely, there are reports of flags to order an INR level that are not activated unless greater than 2 or 3 days pass since the prior INR. Protocols from some major academic medical centers suggest that after a therapeutic INR is reached, INR levels can be measured intermittently, as infrequently as twice a week…”

mentioning

confidence: 99%

Predictors of warfarin‐associated adverse events in hospitalized patients: Opportunities to prevent patient harm

Metersky

Eldridge

Wang³

et al. 2015

Journal of Hospital Medicine

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BACKGROUND The optimum international normalized ratio (INR) monitoring frequency for hospitalized patients receiving warfarin is unknown. OBJECTIVE Assess relationship between daily versus less frequent INR monitoring and overanticoagulation and warfarin‐related adverse events. DESIGN Retrospective cohort study using Medicare Patient Safety Monitoring System data. SETTING Randomly selected acute care hospitals across the United States. PATIENTS Patients hospitalized from 2009 to 2013 for pneumonia, acute cardiac disease, or surgery who received warfarin. INTERVENTIONS None. MEASUREMENTS (1) Association between frequency of INR monitoring and an INR ≥6.0 or warfarin‐related adverse event. (2) Association between the rate of change of the INR and a subsequent INR ≥5.0 and ≥6.0. RESULTS Among 8529 patients who received warfarin for ≥3 days, for 1549 (18.2%) the INR was not measured on 2 or more days. These patients had higher propensity‐adjusted odds ratios (ORs) of having a warfarin‐associated adverse event (OR: 1.48, 95% confidence interval [CI]: 1.02‐2.17) for cardiac patients and surgical patients (OR: 1.73, 95% CI: 1.20‐2.48), with no significant association for pneumonia patients. Cardiac and pneumonia patients with 1 day or more without an INR measurement had higher propensity‐adjusted ORs of having an INR ≥6.0 (OR: 1.61, 95% CI: 1.07‐2.41 and OR: 1.92, 95% CI: 1.36‐2.71, respectively). A 1‐day increase in the INR of ≥0.9 occurred in 621 patients (12.5%) and predicted a subsequent INR of ≥6.0 (positive likelihood ratio of 4.2). CONCLUSION Daily INR measurement and recognition of a rapidly rising INR might decrease the frequency of warfarin‐associated adverse events in hospitalized patients. Journal of Hospital Medicine 2016;11:276–282. © 2015 Society of Hospital Medicine

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“…[9-14] Clinical event monitors have also been shown in certain studies to prevent the development, progression, or mitigate the seriousness of ADRs by enabling the early detection and appropriate response to events in evolution in the hospital and ambulatory care settings. [15-22] Despite the proven benefits of clinical event monitors, few healthcare organizations have implemented and formally evaluated them. [23-26] When used, these systems have frequently been implemented in non-standardized ways that make it difficult to reproduce findings and compare their effectiveness across patients and healthcare settings.…”

Section: Introductionmentioning

confidence: 99%

Computerized detection of adverse drug reactions in the medical intensive care unit

Kane‐Gill¹,

Visweswaran²,

Saul³

et al. 2011

International Journal of Medical Informatics

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Objective Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit. Method This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration. Alerts were assessed using 3 objective published adverse drug reaction determination instruments. An event was considered an adverse drug reaction when 2 out of 3 instruments had agreement of possible, probable or definite. Positive predictive values were calculated as the proportion of alerts that occurred, divided by the number of times that alerts occurred and adverse drug reactions were confirmed. Results 145 patients were eligible for evaluation. For the 48 patients (50% male) having an alert, the mean ± SD age was 62 ± 19 years. A total of 253 alerts were generated. Positive predictive values were 1.0, 0.55, 0.38 and 0.33 for vancomycin, glucose, sodium, and blood urea nitrogen, respectively. A quinidine alert was not generated during the evaluation. Conclusions Computerized clinical event monitoring systems should be considered when developing methods to detect adverse drug reactions as part of intensive care unit patient safety surveillance systems, since they can automate the detection of these events using signals that have good performance characteristics by processing commonly available laboratory and medication information.

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Use of specific indicators to detect warfarin-related adverse events

Abstract: INRs of greater than 3.0 and vitamin K administration appeared to be reliable indicators of warfarin-associated ADEs, and detection with these indicators appeared to reduce ADEs when combined with appropriate interventions.

Cited by 17 publications

References 16 publications

Automated detection of harm in healthcare with information technology: a systematic review

Automated detection of harm in healthcare with information technology: a systematic review

Predictors of warfarin‐associated adverse events in hospitalized patients: Opportunities to prevent patient harm

Computerized detection of adverse drug reactions in the medical intensive care unit

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