Anticoagulation education

Do patients understand potential medication-related emergencies?

Christopher J. Moreland, Richard L Kravitz, Debora A Paterniti, Chin-Shang Li, Tzu Chun Lin, Richard H White

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The Joint Commission Venous Thrombo - embolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats. Methods: From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants. Results: For the 184 patients (38% completion rate), the mean knowledge score was 69% (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59% (95% confidence interval [CI], 57.3%-60.3%). Respondents overestimated non-urgent-severity situations 23% of the time (95% CI, 20.8%-24.7%), while underestimating urgent-severity situations 21% of the time (95% CI, 19.0%-23.9%). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement. Conclusions: Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.

Original languageEnglish (US)
Pages (from-to)22-31
Number of pages10
JournalJoint Commission Journal on Quality and Patient Safety
Volume39
Issue number1
StatePublished - Jan 2013

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Warfarin
Patient Education
Emergencies
Confidence Intervals
Embolism
Patient Safety
Craniocerebral Trauma
Pharmacists
Telephone
Inpatients
Joints
Stroke
Interviews
Hemorrhage
Safety
Education
Surveys and Questionnaires

ASJC Scopus subject areas

  • Leadership and Management

Cite this

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title = "Anticoagulation education: Do patients understand potential medication-related emergencies?",
abstract = "Background: The Joint Commission Venous Thrombo - embolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats. Methods: From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants. Results: For the 184 patients (38{\%} completion rate), the mean knowledge score was 69{\%} (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59{\%} (95{\%} confidence interval [CI], 57.3{\%}-60.3{\%}). Respondents overestimated non-urgent-severity situations 23{\%} of the time (95{\%} CI, 20.8{\%}-24.7{\%}), while underestimating urgent-severity situations 21{\%} of the time (95{\%} CI, 19.0{\%}-23.9{\%}). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement. Conclusions: Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.",
author = "Moreland, {Christopher J.} and Kravitz, {Richard L} and Paterniti, {Debora A} and Chin-Shang Li and Lin, {Tzu Chun} and White, {Richard H}",
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T1 - Anticoagulation education

T2 - Do patients understand potential medication-related emergencies?

AU - Moreland, Christopher J.

AU - Kravitz, Richard L

AU - Paterniti, Debora A

AU - Li, Chin-Shang

AU - Lin, Tzu Chun

AU - White, Richard H

PY - 2013/1

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N2 - Background: The Joint Commission Venous Thrombo - embolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats. Methods: From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants. Results: For the 184 patients (38% completion rate), the mean knowledge score was 69% (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59% (95% confidence interval [CI], 57.3%-60.3%). Respondents overestimated non-urgent-severity situations 23% of the time (95% CI, 20.8%-24.7%), while underestimating urgent-severity situations 21% of the time (95% CI, 19.0%-23.9%). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement. Conclusions: Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.

AB - Background: The Joint Commission Venous Thrombo - embolism (VTE) National Hospital Inpatient Quality Measure VTE-5 outlines four criteria for discharge patient education when starting anticoagulation (usually, warfarin) therapy. The criteria do not specify content regarding patient recognition of potentially dangerous warfarin-related scenarios. A study was conducted to investigate how well patients assess the risks and consequences of potential warfarin-related safety threats. Methods: From an adult population on long-term warfarin, 480 patients were randomly selected for a telephone-based survey. Warfarin-knowledge questions were drawn from a previous survey; warfarin-associated risk scenarios were developed via focus interviews. Expert anticoagulation pharmacists categorized each scenario as urgent, moderately urgent, or not urgent, as did survey participants. Results: For the 184 patients (38% completion rate), the mean knowledge score was 69% (standard deviation [SD], 0.20). Overall classification accuracy of situational urgency was 59% (95% confidence interval [CI], 57.3%-60.3%). Respondents overestimated non-urgent-severity situations 23% of the time (95% CI, 20.8%-24.7%), while underestimating urgent-severity situations 21% of the time (95% CI, 19.0%-23.9%). A significant percentage of patients failed to recognize the urgency of stroke symptoms (for example, loss of vision), the risk of bleeding after incidental head trauma, or medication mismanagement. Conclusions: Despite fair factual warfarin knowledge, participants did not appear to recognize well the clinical severity of warfarin-associated scenarios. Warfarin education programs should incorporate patient-centered strategies to teach recognition of high-risk situations that compromise patient safety.

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