Learning Objective #1: Identify risks associated with anticoagulation management.

Learning Objective #2: Describe the benefits of RN management of warfarin therapy in a clinic setting.

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Anticoagulation therapy has a high risk/benefit profile and oral anticoagulation has a narrow therapeutic index. Management of warfarin therapy by registered nurses (RNs) in a clinic setting offers improved management of persons receiving oral anticoagulation, resulting in outcomes that include, but are not limited to, better regulation of dosage which decreases complications, unplanned hospitalizations and emergency department utilization related to anticoagulation therapy. Through health education provided in the clinic setting, improvement of patient adherence to a prescribed regimen is achieved. Patient education also enables patients to assume greater responsibility for self-care.

A review of literature suggests that maintaining a therapeutic INR range 60-80% of the time prevents complications associated with the condition being managed by anticoagulation and complications associated with anticoagulant therapy. In the RN managed anticoagulation clinic described by the authors, the outcome measure of 70% attainment of INR range +/- 0.2 was established. This indicator is monitored monthly. Currently, the indicator reveals 68% – 71% achievement of INR range +/- 0.2. The percent of patient visits with INR > 4.5 also is monitored. The data shows a 2 - 4% rate.

Patients who had a minimum of 10 visits to the clinic in 2006 were used as their own controls to compare the results of their being managed by the RN in the Anticoagulation Clinic. Comparison of attainment of therapeutic range in 2005 and 2006 was done with these patients. The average INR for each patient was calculated. The findings were significant. In 2005, there was 59% achievement of INR target range +/- 0.2. During 2006, achievement of INR target range +/- 0.2 was 73%. This represents a 14% increase in compliance. This model of care delivery continues to be successful in maintaining safe and compliant therapy.