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Puhakka J, Helsinki Health Centre, GP Suvanto I, Helsinki Health Centre, Head nurse

Implementation of local guideline by interactive workshop improves anticoagulation therapy and patient safety. Puhakka J, Helsinki Health Centre, GP Suvanto I, Helsinki Health Centre, Head nurse Sipilä R, Centre for pharmacotherapy development ROHTO, Medical Advicer.

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Puhakka J, Helsinki Health Centre, GP Suvanto I, Helsinki Health Centre, Head nurse

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  1. Implementation of local guideline by interactive workshop improves anticoagulation therapy and patient safety Puhakka J, Helsinki Health Centre, GP Suvanto I, Helsinki Health Centre, Head nurse Sipilä R, Centre for pharmacotherapy development ROHTO, Medical Advicer 13-16.5.2009 Nordic Congress of Family Practice

  2. Facilitator pairs at each PCUs + ROHTO-activities in Helsinki Health Centre 26 Primary health care units (PCU) Aim: To promote rational pharmacotherapy To improve clinical practices Interactive workshops at PCUs 13.-16.5.2009 Nordic Congress of Family Practice

  3. Background – anticoagulation therapy • Bleeding complications are common and often serious (Landefeld & Beyth Am J Med 1993) • The risks of complications are related to INR control (White et al. Arch Intern Med 2007) • High interaction potential (Raunio H. Suom Laakaril 2005) • Warfarin frequently prescribed to elderly patients with polypharmacy • Concomitant prescriptions for potentially interacting medicines are common in primary care(Snaith et al. 2008 Am J Cardiovasc Drugs) • Warfarin therapy documentation unclear • High volume of these patients in Töölö • INR test is the most prevalent laboratory test in Helsinki Health Centre 13.-16.5.2009 Nordic Congress of Family Practice

  4. Aim • Implementation of Helsinki Health Centre anticoagulation • To improve recording of warfarin therapy to the electronic patient records • To develop shared clinical practices, and to clarify division of professional tasks • Enhance knowledge on anticoagulation therapy • Evaluate the changes in clinical practices 13.-16.5.2009 Nordic Congress of Family Practice

  5. Setting • Helsinki Health Centre • 26 primary care units • 564 500 inhabitants • Coverage 42.3% (outpatient treatment) • 322 GPs, 525 Nurses, 270 other staff • Töölö Health Care Unit • 27 000 population • Coverage 32.9 % • Chief physician and 11 GPs, 8 outpatient consulting nurses, 14 other staff 13.-16.5.2009 Nordic Congress of Family Practice

  6. The steps of Rohto-workshop Problem in practice • Analysis and understanding • Outline of present practices • Baseline audit • Feedback of the results • Evaluation and feedback • Follow-up audit • Participant feedback • Audit results • local facilitators • GP-nurse pair • Supported and trained by ROHTO and regional coordinator • Act as change agentsfor rational pharmacotherapy Change in practice Objectives of change Contract Information • Solutions • based on city’s anticoagulation guideline 13.-16.5.2009 Nordic Congress of Family Practice Picture modified from Rohto

  7. Implementation methods • Baseline audit • A random sample of hundred patients visiting laboratory for INR control during one week • Data collected from electronic patient records • Is indication recorded • Planned duration of the therapy • Target level of the therapy • Workshop • Multiprofessional (21 participants: 10 GPs, 11 nurses + other) • Follow-up audits every six months • New indicator: Warfarin recorded as permanent medicationto the electronic patient record • Feedback of the results on weekly staff meetings and separately for GPs and nurses 13.-16.5.2009 Nordic Congress of Family Practice

  8. Results 1 • Feedback from participants • 6 / 13 WS participants reported an intention to change their clinical practices • 3 no need to change • INR within therapeutic range for 66%, 65%, 77% and 66% in the cases • After the workshop treatment information was generally better recorded 13.-16.5.2009 Nordic Congress of Family Practice

  9. Results 2 : recordings Table I. Percentage of indicators recorded in electronic patient records 13.-16.5.2009 Nordic Congress of Family Practice

  10. Results3: Control intervals Table II. Percentage of patients in different categories of control intervals (weeks) in two follow-up audits 13.-16.5.2009 Nordic Congress of Family Practice

  11. Conclusions • Interactive workshop combined to repeated audits and feedback can lead to improved patient data recordings • Changing clinical practices requires time and effort • These changes may lead to improvedpatient safety • Control intervals are still short in relation to INR levels and city’s anticoagulation guideline • Effect of the implementation and shared clinical practices on treatment control is still unclear 13.-16.5.2009 Nordic Congress of Family Practice

  12. Thank you for your attention! 13.-16.5.2009 Nordic Congress of Family Practice

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