Prevalence of pharmacy-led warfarin patient education in a community hospital: a retrospective review

Introduction: For patients being discharged on warfarin, written education compliant with Centers for Medicare and Medicaid Services VTE-5 criteria is required. Pharmacists, as medication experts, are well positioned to provide education on complex monitoring, dietary restrictions, and medication interactions that accompany warfarin use. Additionally, it is established that student pharmacists can effectively provide clinical services as pharmacist extenders.

Objectives: The primary objective of this study is to determine the proportion of warfarin patients educated by the pharmacy department. The study will also determine which pharmacy personnel are providing educations by reviewing the proportion of educations provided by pharmacists, resident pharmacists, and student pharmacists respectively. Additionally, thirty and sixty day readmission rates and estimated cost associated with providing these educations will be reviewed.

Study Design: This is a retrospective, cross-sectional review of current pharmacy warfarin patient education practices. The proportion of patients educated will be evaluated using simple percentages. Readmission rates will be evaluated using either the Chi-squared or Fischer’s Exact Test depending on observed incidence. The study protocol was approved by the Western Institutional Review Board.

Methods: Medical records of inpatient adults with warfarin orders from February 1 to March 31, 2015 will be reviewed. Patients who were discharged on warfarin will be included in the study up to a goal sample size of 150. Date of pharmacy education, pharmacy personnel providing education, and time spent providing education will be collected, as well as date of discharge and incidence of thirty and sixty day readmission. 

Results: Preliminary reports based on documentation show that 5.33% of patients received warfarin education from the pharmacy department. Pharmacists performed 87.5% of these sessions and 12.5% were performed by student pharmacists. Additional chart review is needed to ensure no sessions were missed due to inconsistent documentation. 

Conclusions: Conclusions pending study completion in April of 2016.