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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Examining Warfarin Dosing Decisions to Improve Anticoagulation Management
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Examining Warfarin Dosing Decisions to Improve Anticoagulation Management

机译：检查华法林剂量决定以改善抗凝管理

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Background: Adherence to relatively simple warfarin dosing algorithms has been found to be effective for improving anticoagulation control, and in turn for reducing adverse events. Achieving consistent use of such algorithms by clinicians managing the care is a known challenge. Objective: To examine warfarin management patterns at anticoagulation clinics in light of algorithm-recommended management and to develop a methodology for quality assurance around this issue. Methods: We reviewed 2711 postappointment clinician notes between October I, 2011, and March 31, 2012, for 481 patients across 5 Veterans Health Administration (VA) sites. Key data gathered were of dosing decisions made following the latest available international normalized ratio (INR). Results: Dosing decisions discordant with algorithm recommendations were made at 45% of all the appointments studied; most (78%) followed an out-of-range INR value, as opposed to an in-range value. We found "signatures of care" at each site, characterized by consistent patterns of concordant and discordant management. For example, some sites were more discordant in terms of one-time dose changes (eg, take an extra dose for I day), while others were more discordant regarding follow-up intervals, and still others regarding the extent of weekly dose changes (usually larger than recommended). It was also not uncommon to change the dose following an in-range value (not recommended). Conclusions: We identified 5 distinct patterns of management across 5 sites; none were particularly adherent to clinical guidelines. Our method is a suitable basis for audit and feedback to help sites improve patient outcomes by practicing in a more guideline-concordant manner.
机译：背景：已发现遵守相对简单的华法林剂量算法可有效改善抗凝控制，进而减少不良事件。由管理护理的临床医生实现此类算法的一致使用是已知的挑战。目的：根据算法推荐的管理方法，检查抗凝诊所的华法林管理模式，并针对此问题开发质量保证方法。方法：我们回顾了2011年10月1日至2012年3月31日之间的271份约会后临床医生笔记，这些笔记来自5个退伍军人卫生管理局（VA）站点的481例患者。收集的关键数据是根据最新可用的国际标准化比率（INR）做出的剂量决定。结果：在所有研究的约会中，有45％做出了与算法建议不符的剂量决策;大部分（78％）遵循的是超出范围的INR值，而不是超出范围的值。我们在每个站点都发现了“护理标志”，其特征是一致和不一致的管理模式。例如，某些部位在一次性剂量变化方面比较不一致（例如，一天服用一剂额外剂量），而另一些部位在随访间隔方面则更加不一致，而其他部位在每周剂量变化的程度上则更为不一致（通常大于推荐值）。按照一定范围内的值更改剂量也是很常见的（不推荐）。结论：我们在5个站点中确定了5种不同的管理模式。没有人特别遵守临床指南。我们的方法是进行审核和反馈的合适基础，可通过以更符合准则的方式进行练习来帮助站点改善患者的预后。

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