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Learning Objective 1: Identify a “high-alert” drug can cause adverse events such as fatal bleeding or thrombosis that lead to emergency room visits.
Learning Objective 2: Identify the maximum number of weeks of oral anticoagulation therapy that may still be considered for short-term thaerapy use.
with an educational program for registered nurses and physical therapists.
Ivestigaotor: Tanya Schlemmer
Institution: Texas Health Presbyterian Dallas Home Healthcare
The purposes of the study are to: 1. Describe the number and percentage of patients on short-term (less than or equal to six weeks) oral anticoagulation therapy (OAT) and long-term (six weeks or more) OAT during a one-year period (August 31, 2007 – July 31, 2008); 2. Describe the number and percentage of patients on long-term therapy within the preset therapeutic treatment range [for International Normalized Ratio (INR)]; 3. Describe the number and percentage of patients with outlier events (occasions of INR value 1-point outside of pre-set range); and 4. Describe adverse events related to OAT, whether the INR was within or outside of pre-set range.
Conceptual/Theoretical framework or rationale for study
The Joint Commission (TJC, 2007) 2008 National Patient Safety Goal (NPSG) mandated safety improvements for anticoagulation therapy. The Institute for Healthcare Improvement (IHI) (2007) targeted anticoagulants as “high-alert” drugs for improvement.
Methodology: Design, setting, sample, procedure, instruments, and data analysis
A retrospective, descriptive study conducted of homecare patients taking OAT. There were 186 of 2611 eligible charts. Of these, 28 were in storage leaving 158 charts available for review. Number of OAT charts were 7% (N = 158), with 67% (N = 125) of these identified as short-term therapy, 16% (N = 30) as long-term therapy, and 2% (N = 3) having both therapies.
Results (for completed studies)
Long-term OAT patients remained within the pre-set therapeutic INR range 58% of the time during the time period of pre-clinician teaching and 71% of the time during the post-clinician teaching period. There were five patients out-of-range for both evaluations with six outlier events and five adverse events for 2.5% of the patients.
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