Most staff are likely aware of the multiple improvement efforts UF Health Jacksonville has successfully implemented to decrease hospital-acquired infections, improve sepsis survival rates and enhance care coordination for patients between inpatient-outpatient transitions. Those efforts have helped decrease 30-day hospital readmissions and improve the aftercare course for patients.
But there are many other initiatives happening quietly behind the scenes that result in safer patient care and improve quality metrics. An example is the unique collaboration between quality data engineers, the pharmacy team and the physician medical staff to enhance warfarin safety.
Warfarin, sold under the brand name Coumadin, is a medication used after certain cardiac and vascular procedures to prevent the formation of blood clots. The patient’s blood is anticoagulated to specific parameters using a laboratory test called the international normalized ratio, or INR. If the INR is too low, the patient is at risk for developing blood clots following the procedure. If the INR is too high, the patient could be at risk for bleeding. Keeping the medication at the correct, narrow range can be challenging.
Quality data engineers, the pharmacy team and the physician medical staff have collaborated to enhance warfarin safety at UF Health Jacksonville.
An electronic INR surveillance program for patients on warfarin was developed by the quality data engineers and pharmacy informatics team. Like the sepsis surveillance program Azrael, the INR surveillance program scans through the electronic medical record system and notifies the physician care team and the pharmacy team if the INR goes above a certain level. This allows the teams to modify the medication dose to keep the ratio in the narrow therapeutic level.
The pharmacy manager reviews all patients on warfarin on a daily basis and identifies opportunities for improvement to the protocol and/or education of the pharmacists and medical staff. Seven days a week, inpatient pharmacists monitor each patient who is receiving warfarin and contact providers with recommendations for patients on non-consult services. This is done on rounds or via the secure chat function in the electronic medical record system.
In October, Pharmacy implemented a medical staff-approved, pharmacist-managed warfarin protocol for the hospital medicine service as a pilot program for UF Health Jacksonville. Pharmacists enter a progress note to document their findings and actions. The work by data engineers, pharmacy, laboratory and providers to enhance warfarin safety has resulted in a system that responds more rapidly. Since the implementation of these efforts, very few INR levels have reached undesirable levels from a quality perspective.