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| Deficits in Warfarin Discharge Planning: Improving Transitions of Care for Patients on Warfarin at a Community Teaching Hospital |
| Krista Luck, Amira Carter, Sesalie Rhinehart, Elizabeth Ramsaur, Christie Dresback Mission Hospital, Asheville, NC, United States |
Introduction The majority of medication errors occur as patients transition between levels of care. These errors are more concerning with anticoagulants. Patients discharged from the inpatient setting on warfarin should receive standardized instructions and follow-up to minimize risk of harm. The goal of this project is to improve transitions for patients on warfarin by identifying incomplete discharge plans. Methods A retrospective chart review identified patients with incomplete warfarin discharge plans. A complete discharge plan includes discharge INR, clear dose instructions, follow-up INR appointment and completed discharge anticoagulation form. The primary endpoint is the identifying the number of patients with a complete discharge anticoagulation plan. Secondary endpoints include patients with a 90-day readmission for a bleeding or thromboembolic event, elements omitted from the discharge plan, significant drug interactions, characterization of INR at discharge and if warfarin-naive patients received education at discharge. Patients included in the study were admitted between June and December 2023 and on current warfarin therapy. Patients managed by the advanced heart failure team were excluded. Data were collected by manual chart review. Results Of the 105 patients who met inclusion criteria, only 10% of discharge plans were complete. All patients had INR documented at discharge and all but 2 patients had clear warfarin instructions. Only 31% of patients were scheduled for a follow-up INR. A 90-day hospital readmission for an adverse event occurred in eight (7.6%) patients of which none had a complete discharge plan. Education was provided to 53.8% of warfarin naive patients at discharge. Approximately 42% of INRs measured at hospital discharge were therapeutic. There were 27 instances of significant drug interactions noted. Conclusion The anticoagulation discharge form was developed to ensure patients have essential warfarin-related information available to providers to ensure seamless discharge process. Events noted in this study could have been related to missing data about anticoagulation at discharge. Based on the study findings improvements are needed regarding use of the form and the importance of scheduling follow-up INR appointments. |