Electronic Health Records May Improve Warfarin Management

Warfarin treatment plans change often, and paper forms may be inadequate.

Adopting a new, more inclusive electronic health record (EHR) system may help hospitals improve the care received by patients taking warfarin. Improved EHRs could improve care coordination and reduce confusion among different healthcare professionals treating the patient, according to a new study published by The Joint Commission Journal on Quality and Patient Safety.

Warfarin is a common blood thinner that effectively reduces the risk of blood clots and associated events, such as heart attack or stroke. Despite its popularity, warfarin requires consistent monitoring, and can lead to serious adverse events when mixed with vitamin K, which is found in certain vegetables.

The use of EHRs may be able to reduce confusion and improve patient outcomes by outlining important steps to take after being discharged from the hospital, according to the study.

"Previous research indicates that adverse effects of warfarin accounted for 33 percent of annual emergency hospitalizations for patients 65 or older in the United States," said researcher Margaret Day, MD. "At MU [University of Missouri] Health Care, we designed the 'Outpatient Warfarin Management Order' record in response to The Joint Commission's call for institutions to reduce possible patient harm associated with the use of warfarin."

Prior to the intervention, physicians would draft a treatment plan on paper, which made it difficult for other healthcare providers to obtain the information. Paper forms for warfarin also caused confusion among pharmacists, physicians, and patients, since the treatment plan tends to change frequently, according to the study.

Currently, MU Health Care uses an EHR that consists of a health summary of each patient admitted to the hospital. The team of researchers found that a discharge summary was a valuable way for physicians to communicate next steps for patients and providers to manage warfarin treatment.

"The information entered is visible to the patients and their community health care providers," Dr Day said. "In addition, the record also coordinates communication to pharmacy services for any dosage updates."

The researchers discovered that 42% of patient discharge charts contained important factors that are critical for managing warfarin therapy for these patients. After implementing the new EHRs, 78% of the discharge records included these factors, according to the study.

The investigators then surveyed the physicians and pharmacists who used the new EHR system.

"Of the 28 physicians and pharmacists who took part in the survey, 61 percent said that the new warfarin order was 'user friendly and accessible,'” Dr Day said.

These findings demonstrate the importance of a comprehensive EHR system for use among patients on warfarin or other anticoagulants when treatment in different settings is necessary. Additionally, the new system provides notification about the transition care to patients’ primary care providers, and allows for collaborative care with pharmacies, which will result in reduced patient harm, the study concluded.