A before and after study of warfarin monitoring in a single region as part of the Scottish patient safety programme in primary care

Abstract

The introduction of a complex safety improvement intervention via a national patient safety programme has resulted in modest improvements in the control of warfarin monitoring in a single region. These improvements may potentially reduce the incidence of serious adverse events. The study method, interventions and findings should be of interest to primary care settings with similar warfarin management arrangements internationally.

The Scottish patient safety programme in primary care: context, interventions and early outcomes

“…For example, it is difficult to attribute a reduction in hospital admission to better medication reconciliation or safer prescribing of high-risk drugs because of other initiatives taking place across a healthcare system which can affect this measure. As part of SPSP-PC, improving Warfarin management offered an opportunity to link outcome measures of better anti-coagulation control with more reliable processes, with one NHS Board currently demonstrating encouraging and significant improvement evidence (see McNab et al 22 in this edition). What is not yet known is the overall impact of the programme on primary care safety culture, the safety of practice systems and if there is a reduction in the number of events which cause avoidable patient harm from healthcare delivered by general practices across NHS Scotland.…”

Qualitative evaluation of the Safety and Improvement in Primary Care (SIPC) pilot collaborative in Scotland: perceptions and experiences of participating care teams

“…The study findings are informing the (re)design and delivery of a planned future safety and improvement programme to be implemented nationally in Scottish general practices, before spreading to other primary care professional groups. Further testing and refinement of the programme interventions are ongoing with more representative groups of GP teams, with some having demonstrated promise in their reported potential to improve the reliability of clinical safety systems 44 and identify previously undetected patient safety concerns. 45 The potential for some of the tools to support QI evidence requirements for GP specialty training and medical appraisal and revalidation is also apparent.…”

“…45 The potential for some of the tools to support QI evidence requirements for GP specialty training and medical appraisal and revalidation is also apparent. 44–47 …”

Warfarin as a materially and digitally informed drug

“…Of immediate concern, warfarin is one of the top three drugs associated with hospital admissions, she explains, especially in the elderly population. Many of these admissions are readmissions due to some patients’ inability to control their INRs and, as such, they are regarded as preventable (McNab et al, 2015). The stakes are further heightened because warfarin is one of the drugs most associated with fatal medication errors (Hart-George, 2013) and as a hospital pharmacy poster warns: 15 percent of all doctors’ prescriptions contain errors.…”