Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: a multidisciplinary practice improvement project

Background: Warfarin is a very complex, high risk therapy and one that carries the potential for severe adverse events. The aim of this project was to improve warfarin management through the application of the best available evidence. The project was undertaken in a 250 bed acute care metropolitan private hospital. Interventions: A suite of evidence-based interventions were used including audit and feedback, patient and provider education, and decision support aides. Measures: This project used the ongoing collection of warfarin process and outcome clinical indicator data to measure improvement. Results: Compliance with loading protocol increased by 12% (42–54%); patient education prior to discharge increased by 54% (31–85%); INRs > 5 decreased by 2.6% (3.7–1.1%); and abnormal bleeds fell by 1.2% (1.2–0%). Conclusion: This multifaceted suite of interventions was successful in influencing clinician behaviour and improving compliance with evidence-based warfarin guidelines.