Impact of introducing anticoagulation-related prescribing guidelines in a hospital setting using academic detailing

Gregory William Roberts¹, Robert Adams²

¹Pharmacy Department, Repatriation General Hospital, Daws Road, Daw Park, SA, Australia; ²Department of Medicine, Queen Elizabeth Hospital, Woodville Road, Woodvillle, SA, Australia

Aim: Assess the impact of using academic detailing-assisted guideline roll-out on warfarin initiation, reversal of warfarin overanticoagulation, and uptake of deep vein thrombosis (DVT) prophylaxis across 4 metropolitan teaching hospitals.

Methods: Baseline data were collected for 3 months prior to intervention. Prescribers were then informed about the guidelines, including feedback of current hospital performance and the basis for the guidelines. Post-intervention data were collected for 3 months after guideline implementation.

Results: Uptake of DVT prophylaxis in medical patients increased from 52.8% to 67.0% (p=0.004). No impact on operative surgical patients was seen, possibly due to the high preexisting rate of uptake (86.1% vs 84.1%, p=0.7). DVT prophylaxis rates in non-operative surgical patients were similar to medical patients, with similar, but non-significant improvements. The time to reach a stable therapeutic international normalized ratio (INR) after warfarin initiation was reduced (p=0.03) as were the number of INR’s >4 in the first week of therapy (p=0.03). There were significant improvements in appropriate vitamin K use for warfarin overanticoagulation in patients with an INR above 6 (48% vs 74%, p=0.007), timely follow-up tests (49% vs 62%, p=0.009), and the proportion of next INR’s being less than 4 (49% vs 61%, p=0.04).

Conclusions: The use of academic detailing to facilitate guideline roll-out had a positive impact on nearly all areas studied. The academic detailing process within the hospital setting was received enthusiastically by prescribers.

Keywords: warfarin, overanticoagulation, DVT prophylaxis, elderly, academic detailing