Best Tests November 2006
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Kōwhai tackles overdue INRs
As part of Kōwhai Health Trust’s quality initiative programme, a system was devised to provide a reliable, safe and effective warfarin management service to patients. This “best practice” management covered the initiation of treatment, education, monitoring, follow-up and discontinuation of warfarin treatment.
The main aims of the initiative were to:
- Provide GPs with guidelines for managing anticoagulation with warfarin.
- Provide a framework for transfer and continuation of treatment between secondary and primary care.
- Maintain the INR of selected patients within the therapeutic range for the appropriate length of time.
- Set up a safety net to detect patients on warfarin therapy who have not had an INR in the previous seven weeks.
Guidelines were developed in conjunction with Hutt Hospital physicians. Warfarin management services were provided to residents of the Hutt Valley.
To address the aims of the programme, the following changes took place:
- Patients commenced on warfarin therapy in secondary care were issued a voucher on discharge from hospital, which entitled them to a free GP follow-up visit to reinforce education on warfarin management.
- Alterations were made to the electronic discharge process, which required medical staff to ensure that warfarin dose, indication for treatment, target INR, recommended duration of treatment and latest INR were included in the information passed on to the GP.
- In conjunction with the local community laboratory, a computer based ‘safety net’ was developed to detect patients overdue for an INR test. A list of patients receiving regular INR tests is created every 3 weeks. This list is then screened to detect patients who have not had an INR test in the past 7 weeks, the information is then passed on to the patients’ GPs.
The outcome of Kōwhai Health Trust’s warfarin management programme has so far been positive. At the start of the programme, 8% of the approximately 1200 patients receiving regular INR tests were overdue for testing. This figure has now reduced to less than 3%, a desirable outcome for both GPs and patients.
Although management programmes such as this are labour intensive in the initial development phase, the systematic approach to ensuring best quality management of patients has had significant positive benefit for patients and practitioners. It is an excellent example of improved outcomes through close co-operation and linkages between primary and secondary care.
Kōwhai Health Trust was established in 2004 to provide healthcare management services. It currently provides service for Hutt Valley DHB and Mid Valley and Valley PHOs, along with various other organisations in the Hutt Valley and Wellington region.
Thank you to Dr Gary Brown for this report.