EHRs help ensure proper patient use of blood thinners
Medication adherence is critical for patients, especially when it comes to blood thinners prescribed after they leave the hospital. In particular, electronic health records have demonstrated value in assisting with anticoagulation therapy between outpatient and inpatient settings and across multiple providers.
That’s the finding of a study from the University of Missouri Health Care, which found that using EHRs can improve the care of patients on warfarin, a commonly prescribed blood thinner used to prevent harmful clots, as well as eliminate potential confusion among providers and pharmacists.
Margaret Day, MD, a primary care physician and medical director at MU Health Care’s Family Medicine-Keene Clinic, contends that the use of warfarin can be “potentially very complicated and dangerous,” and that’s borne out by the fact that adverse effects of the drug accounts for 33 percent of annual emergency hospitalizations for patients 65 or older in the United States.
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According to Day, the Joint Commission has called on healthcare organizations to reduce possible patient harm associated with the use of warfarin, a drug that requires frequent monitoring, daily dosing and can result in serious negative effects when mixed with vitamin K, which is found in vegetables such as lettuce or broccoli.
To ensure proper use of the medication for patients, MU Health Care designed an “outpatient warfarin management order” record in their Cerner EHR system that generates a comprehensive health summary for each admitted patient to make the process safer. Day says that her team found the discharge summary to be a valuable tool to communicate five key elements needed for patients and providers to manage the anticoagulation therapy.
She notes that physicians are prompted at patient discharge to enter five key elements when ordering warfarin management, such as the reason a patient is taking the drug and what their goal is for the indication for anticoagulation, target International Normalized Ratio (INR).
“The information entered is visible to the patients and their community healthcare providers,” Day adds, emphasizing that it’s vital to get the warfarin dosage just right. “In addition, the record also coordinates communication to pharmacy services for any dosage updates.”
Under the prior process, physicians would give patients paper-based warfarin management plans, which made it difficult for providers to later obtain that information. However, paper forms sometimes caused confusion among pharmacists, physicians and patients since the warfarin plans could change frequently.
Before implementing the new record, Day and her team conducted a survey which revealed that 42 percent of patients' discharge charts included key elements for discharging patients on warfarin. After the outpatient warfarin management order was implemented in the EHR, that percentage nearly doubled to 78 percent. Further, 61 percent of physicians and pharmacists surveyed who used the new warfarin order indicated that it was user friendly and accessible.
“We know that hospital transitions are potentially high-risk times for errors, particularly medicine errors for patients, and warfarin presents some special challenges because of the nature of the medicine,” she concludes, adding that the outpatient warfarin management order fits right into the clinical workflow.
The new process not only provides notification about the transition care to patients’ referring providers in their communities, but also facilitates collaborative care with pharmacies, according to Day.