St. Vincent's Clinic

Safer Warfarin Therapy

A special safety project was introduced to improve the management of Warfarin throughout the Hospital. One of the most prescribed drugs in Australia, warfarin has PBS records showing almost two million prescriptions dispensed last year. However, due to its narrow therapeutic window warfarin is a difficult drug to use.

If a patient takes a dose larger than they can tolerate, they are at risk of lifethreatening bleeding. If they receive too low a dose, they are at risk of potentially fatal blood clots. According to NSW Health 2007 data, warfarin is the third most common drug reported in in-patient medication incidents, after morphine and paracetamol.

With these risks in mind, St Vincent’s Private Hospital ran a Warfarin Safety Project to facilitate improved clinical outcomes. Outcomes included increasing the percentage of patients that receive warfarin education, increasing the percentage of patients whose starting dose is consistent with approved protocol and maintaining adverse outcomes below the Australian Council on Healthcare Standards national benchmark.

The project successfully implemented a number of interventions to increase warfarin safety, including reworking the warfarin educational material and translating it into French for Cafat patients, sourcing a warfarin education DVD, developing a warfarin knowledge assessment tool and patient education checklist as well as implementing warfarin commencement and reversal guidelines for Visiting Medical Officers.

The project has been one of the first in NSW to utilise the Clinical Excellence Commission’s (CEC) new Quality Use of Medicine performance indicators. The CEC’s performance indicators have allowed for the measurement and benchmarking of current warfarin policies, processes and outcomes at St

Vincent’s Private Hospital. Nationally recognised, the Warfarin Safety Project has received two peer reviewed awards, the Australian Private Hospitals Association Baxter Award for Clinical Excellence and Patient Outcomes and the Australian Council on Healthcare Standards Quality Improvement Award.

Made possible by the support of St Vincent’s Clinic, the project received a multi-disciplinary patient-focused research grant of $25,000.