Warfarin dosing and follow-up : adherence to the local guideline at a health centre in Malta

Abstract

BACKGROUND: Point-of-care testing (POCT) describes any test performed outside hospital where the result influences patient management.

OBJECTIVE: This study aimed to establish whether warfarin dosing and follow-up at the local point-of-care (POC) clinic at Cospicua Health Centre (CHC) was performed in adherence to the locally provided ‘Clinical Standard Operations Procedures for Health Centre POC-Based ACC Guideline’ which is based on previous guidelines as published by the British Committee for Standards in Haematology (BCSH) on POCT.

METHOD: A set of five random consecutive entries for each of 50 randomly selected patients attending the POC clinic at CHC between January and September 2019 were analysed. The data collected included indication for anticoagulation, International Normalised Ratio (INR) result on date of dosing, new warfarin dose prescribed and follow-up given in days/weeks. Eligibility criteria included records of a minimum of five consecutive uninterrupted visits and a target INR range of 2-3, 2.5-3.5 or 3-4.

RESULT: A total of 250 entries were studied, and found to be mostly female patients (60%). The most common indication for anticoagulation in the population was atrial fibrillation (70%). Warfarin dosing was performed according to the local guideline in 80.4% of recorded entries. However, follow-up date given was only according to the local guideline in 42.8% of cases.

CONCLUSION: The lack of guideline adherence to local dosing and follow-up recommendations may lead to unsafe warfarin prescribing, increased healthcare resource expenditure and unnecessary appointments at busy POC clinics. Stricter adherence to the local guideline and implementation of an improved system of documentation remains desirable. The reasons behind this needs to be studied further when dedicated software was made available to doctors to aid in warfarin dosing.