Implementation of a Computerized Decision Support System for Warfarin Dosing in Hemodialysis Patients: A Study of Effectiveness and Safety
Statement of the problem: The risk-benefit profile of warfarin anticoagulation in hemodialysis (HD) patients differs compared to the non-HD population. Computerized decision support systems (CDSS) to assist with anticoagulation management are safe and effective in the non-HD population but had not p...
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| Language: | en |
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Université d'Ottawa / University of Ottawa
2015
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| Online Access: | http://hdl.handle.net/10393/31998 http://dx.doi.org/10.20381/ruor-2735 |
| Summary: | Statement of the problem: The risk-benefit profile of warfarin anticoagulation in hemodialysis (HD) patients differs compared to the non-HD population. Computerized decision support systems (CDSS) to assist with anticoagulation management are safe and effective in the non-HD population but had not previously been studied in HD outpatients.
Methods of investigation: A before – after study compared anticoagulation control during pre-existing, nephrologist-led anticoagulation management to that following implementation of a pharmacist-led, CDSS-assisted strategy, in HD patients on warfarin at The Ottawa Hospital.
Results: Forty-two patients were included. Following implementation of the CDSS-assisted strategy, median time-in-range increased by 3.7% (IQR, -9.5% - 20.6%; p = 0.247). Median frequency of INR tests per day decreased: -0.040 (IQR, -0.074 to –0.0008; P = 0.0001). Adverse events were similar.
Conclusion: A CDSS-assisted strategy for anticoagulation management in HD patients is effective, safe and may lead to cost savings related to less frequent INR testing. |
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