Reducing Warfarin ADR’s with a Nurse Led Anticoagulation Clinic: A New Model of Patient Care

Introduction: Warfarin was the leading cause of drug related adverse events at South Miami Hospital, which resulted in 27 hospital admissions in a year. A retrospective chart review revealed that patients were being discharged without a clear plan for follow up and management. Having optimal outcomes as a result of Warfarin therapy depends on maintaining the INR (International Normalized Ratio) in its range. In order to do so, high-quality anticoagulation management (HQACM) is required. Methods: In response to the increased in Warfarin toxicity hospital admissions and community physician’s concern regarding anticoagulation safety, an interdisciplinary team was formed to address the problem. A nurse led clinic was created to provide an outpatient setting staffed with nurse experts to whom physicians can refer their anticoagulation patients for safe, evidence-based clinical warfarin management. Patients are carefully monitored and data regarding ADRs are analyzed and reported to the SMH Pharmacy and Therapeutics committee. Results: Today Warfarin drug related adverse events admissions have decreased significantly to less than 10 admissions per year and this number has been sustained. It is evident that the anticoagulation clinic is a remarkable resource for education, monitoring, and Warfarin management. Discussion: The clinic uses evidence-based guidelines to make dosing adjustments and follow up intervals. This model has been effective of reducing Warfarin toxicity admissions by 74% since its opening. Patients continue to appreciate the timeliness and convenience of their Warfarin management