A project to improve the management of patients on warfarin in a primary care setting through the introduction of a POC analysis

Abstract

When noticed that patients commonly misunderstood their warfarin prescriptions when they were given by telephone. We found that the average TIR (time in range) (the relative time period the patients PT-INR value was in the therapeutic range) for patients decreased, and we noticed that the numbers of incidents increased. We made several interventions over a period of close to three years (2010-2012) to improve the quality of care, increase patients' TIRs, and decrease incidents. The interventions included; taking extra care when speaking to patients about their warfarin prescriptions on the phone and using an express mail delivery system to make sure patients got their letters in time. However, these changes made little difference to the measured results. In 2012, we introduced a point of care analysis. Through these simple actions TIR figures increased from 55 % to 75-80 % and fewer non-conformance reports were filed. Medical incidents, leading to costly hospitalizations, after the introduction of POC (point of care analysis) fell from six to two to three instances a year. The number of patients undergoing treatment and included in the study increased from 200 in 2008 to 250 in 2015. We found that these changes improved the quality of the care given without causing extra work for the staff. Patients were satisfied and the method has spread to other primary care centres.