Date of Degree

12-2018

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Karen L. Weis

Advisor

Cecelia Ann Kothmann

Abstract

Background. Coumadin is the most commonly prescribed oral anticoagulant worldwide and is safe and effective in the prevention and treatment of stroke and venous thromboembolism (Stoudenmire, DeRemer, & Elewa, 2014). Coumadin is dangerous when poorly managed due to high risk for bleeding and mortality. It is best managed using evidenced-based models of care such as point-of-care (POC) International Normalized Ratio (INR) testing (Garcia et al., 2008; Harrison, Shaw, & Harrison, 2015; Rossiter, Soor, Telner, Aliarzadeh, & Lake, 2013). Purpose. Establish a Coumadin Clinic in a rural family medicine practice with POC INR testing to improve anticoagulant management. Methods. A quality improvement project was conducted to implement all components of the Coumadin Clinic, to evaluate the time within therapeutic range (TTR) of INR for all patients on Coumadin therapy, and to evaluate patient and staff satisfaction. Components of the Coumadin Clinic were monitored for accomplishment using a checklist at each INR visit. Each patient’s pre-intervention TTR was compared to the post-intervention TTR and patient and staff satisfaction were evaluated by questionnaire. Results. Results indicate that 50% of patients had improved TTR following implementation of POC INR testing, staff completed each component of a complete Coumadin Clinic visit 84% of the time, and 100% of staff and 87.6% of patients were satisfied with anticoagulant management at the POC. Conclusions. A Coumadin Clinic using POC INR testing is an evidence-based model of care that is effective in Coumadin management.

Keywords: Coumadin, Coumadin Clinic, point-of-care, International Normalized Ratio, time within therapeutic range

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