Warfarin is an oral anticoagulant used to prevent and treat thromboembolism. The narrow therapeutic index of this medication coupled with the considerable intra- and inter-patient variability in response markedly complicate management. Clinically significant adverse events can result from under- or over-anticoagulation, namely thromboembolism or significant bleeding respectively.
A crucial requirement for optimisation of safety and effectiveness of therapeutic range therapy is therefore regular measurement of the international normalised ratio (INR) to evaluate the impact of warfarin, followed by appropriate dose adjustments to maintain the INR within the target.
What are the key issues that patients need to know?
- Benefits of warfarin treatment relative to the risks
- Need for effective communication and relationships with their health care professionals
- Need for regular blood tests to determine the extent of anticoagulation and dose adjustments if required to maintain the INR within the target therapeutic range
- Identification of the correct warfarin brand
- Potential for drug interactions with warfarin
- Effects of foodstuffs and alcohol on warfarin
- Need to adhere to regular daily dosing and what to do if a dose is accidentally omitted
- Recognition and management of adverse events
- Need to avoid hazardous activities
Warfarin Education Process
The Warfarin Education Programme consists of a toolkit of resources suitable for carry out structured, comprehensive, one-on-one education for all patients on warfarin.
- Use the Pre-Education Patient Evaluation Tool to identify any patient or resource related barriers requiring management:
- ability to understand English and need for an interpreting/translating service during the education session
- ability to manage own warfarin treatment and the need for caregiver management
- access to telephone for communication with health professionals
- access to transport for laboratory visits for blood tests
- Conduct education session using the Warfarin Flipchart as an aid for both the patient and educator
- patient view consists of pictures and simple text for patient education and the reverse side consists of a teaching tool for the educator
- some pages in the flipchart should be used for the education of all patients, e.g. pages describing two brands of warfarin in New Zealand
- some other pages are specific to particular patient groups, e.g. patients with artificial heart valves
- Customise the Warfarin Patient Information Card during the session as a take-home reminder for the patient.
- Give patient a warfarin diary so they can record all details of INR monitoring and dosing
- Use the Post-Education Checklist to ensure all key points have been discussed with patient
- Assess patient's knowledge and understanding using the Warfarin Knowledge Evaluation Tool
- during this evaluation process encourage patient to look for answers on the Warfarin patient information card, to ensure their familiarity with this resource
- Reinforce key messages if the patient is found to have any knowledge gaps or difficulty understanding the messages
- Communicate any issues or concerns to the prescribing clinician
For further information, please email email@example.com.
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