Adjustment of warfarin loading doses for age exhibits clear superiority over the use of Fenn or Emp. This becomes increasingly important as the average age of patients being warfarinised increases, with the recognition that atrial fibrillation requires anticoagulation. Fenn consistently overdosed elderly patients, especially those aged 80 years and older.

This commentary is based on the experience of teaching and observations of how pharmacy technician students can expand their perspective on patient safety by using real-life student-gathered patient data collected from community pharmacies. Pharmacy technicians in Denmark work extensively with counselling on the safe and efficient use of medications. Final-year pharmacy technician students can take the elective course in Clinical Pharmacy in Community Pharmacy, which targets the students who wish to work in depth with patient communication and quality assurance in counselling. One assignment that forms part of the course is for students to collect data about patients’ beliefs about medications. Teachers’ observations suggest that when students gather and work with their own data, they change their perspective on patients’ beliefs about medications. It also strengthens the students’ awareness of their responsibility for ensuring patient safety and contributes valid data to research in pharmacy practice.

Background Guidelines recommend re‐initiating post‐operative warfarin at the previous maintenance dose. This results in prolonged re‐establishment of a therapeutic international normalised ratio (INR). Modelling warfarin initiation and subsequent INR response using previously published data indicated that re‐initiation with twice the maintenance dose for 3 days may provide a rapid alternative. Aim To compare the time to a stable therapeutic INR for conventional maintenance dose re‐initiation of warfarin with a loading dose strategy. Method Warfarin maintenance doses were adjusted by using the standardised maintenance dose – a theoretical dose resulting in an INR of 2.5. The test group was re‐initiated on warfarin doses twice their standardised maintenance dose on Days 1, 2 and 3 and on Day 4 reverted to their maintenance dose. The guideline group was re‐initiated on warfarin doses equivalent to their standardised maintenance dose on these days. Results The test group (n = 17) achieved a therapeutic INR more rapidly than the guideline group (n = 23; p < 0.001) with median times to therapeutic INR of 3 and 6 days respectively. After 3 doses the test group INR on Day 4 was in the therapeutic range (2.1±0.4) and significantly higher than the guideline group (1.7±0.5; p = 0.002). No patient in the test group experienced an elevated INR (maximum INR 3.3). Conclusion INR response to the warfarin re‐initiation dose was dependent on the magnitude of the induction dose relative to the maintenance dose. The loading dose strategy achieved a stable therapeutic INR more rapidly than conventional practice. Prospective investigation in surgical patients is needed to confirm its clinical applicability.