AN EVALUATION AND IMPROVEMENT PROGRAM FOR INPATIENT ANTICOAGULANT CONTROL

To improve the management and therapeutic control of inpatients on ant icoagulant drugs, combined prescription and monitoring charts have bee n developed for both heparin and warfarin which incorporate clinical g uidelines. These have been introduced throughout a 700-bedded acute te aching hospital via a structured program of change management. We have demonstrated improvements in the quality of anticoagulant control (as sessed with a custom-written computer program), adherence to clinical guidelines and quality of monitoring and prescribing of anticoagulants in inpatients. The percentage time spent under-anticoagulated with he parin (activated partial thromboplastin time ratio <1.5) fell from 32. 7% to 18.5% (p<0.0001), whereas there was no change in percentage time over-anticoagulated (5.1% vs. 5.8%; p = ns). The percentage time spen t under-anticoagulated with warfarin was unaltered (26.3% vs. 29.8%; p = ns) but the percentage time spent over-anticoagulated (Internationa l Normalised Ratio >4.5) was halved from 5.4% to 2.7% (p<0.001). We co nclude that the introduction of the charts led to significant improvem ents in anticoagulant control.