Effectiveness of a technological tool associated with pharmaceutical guidance in hospital discharge of patients using warfarin
Main Article Content
Keywords
Pharmacists, Warfarin, Patient Discharge, Pharmaceutical Services, Biomedical Technology, Information Technology
Abstract
Introduction: Warfarin is an anticoagulant considered a high-alert medication by the Brazilian Institute for Safe Practices in the Use of Medicines. It is the clinical pharmacist who advises patients on safety and adherence to this therapy. Lack of patient guidance can lead to undesirable outcomes, from readmissions to deaths. Objective: The objective of this study was to evaluate the impact of the use of a technological tool associated with the role of the clinical pharmacist in a tertiary hospital in guiding patients on the use of warfarin. Method: Cohort research with 960 patients using warfarin from 2017 to 2020 and discharged from hospital. Information was compared between the period before (G1) and after (G2) the implementation of the technological tool that searches for specific keywords in real time in the hospital operating system. Results: There was a greater range of patients advised at hospital discharge, going from 57.4% in G1 to 74.9% in G2 (p<0.001). The implementation of a technological tool in the hospital system allowed the identification of discharged patients using warfarin in real time. Internal failures can be avoided through the implementation of health technologies. This was evidenced in our research. Warfarin belongs to a group of high-alert medications and all patients in this group could benefit from technological tools. We understand that despite some perceived limitations, the application achieved the purpose for which it was developed, and its use could, in the future, be extended to other medicines and internal hospital processes. Conclusion: Health technologies can benefit both patients and healthcare professionals, as demonstrated by the greater scope of patients guided by clinical pharmacists at hospital discharge. New strategies must be developed for outpatients and home monitoring, given the scarcity of similar studies.
References
2. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Collins R, Camm AJ, Heidbüchel H; ESC Scientific Document Group. The 2018 European Heart Rhythm
Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39(16):1330-1393.
3. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy: antithrombotic therapy and
prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest
2012; 141(2 Suppl):e44S-e88S.
4. Nutescu A, Burnet A, Fanikos J, Spiler S, Wittkowsky A. Pharmacology of anticoagulants used in the treatment of venous
thromboembolism. J Thromb Thrombolysis 2016; 42(2):296-311.
5. Zehnder JL. Fármacos usados nos distúrbios da coagulação. In: Katzung BG. Farmacologia básica e clínica. 10 ed. Porto Alegre:
AMGH, p. 487-502, 2010. Portuguese.
6. Patel S, Singh R, Preuss CV, Patel N. Warfarin. 2022 Sep 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022.
7. Barr D, Epps QJ. Direct oral anticoagulants: a review of common medication errors. J Thromb Thrombolysis 2019; 47(1):146-154.
8. Triller D, Myrka A, Gassler J, Rudd K, Meek P, Kouides P, Burnett AE, Spyropoulos AC, Ansell J. Defining Minimum Necessary Anticoagulation-Related Communication at Discharge: Consensus of the Care Transitions Task Force of the New York State Anticoagulation Coalition. Jt Comm J Qual Patient Saf 2018; 44(11):630-640.
9. Clark NP. Role of the anticoagulant monitoring service in 2018: beyond warfarin. Hematology Am Soc Hematol Educ Program 2018; (1):348-352.
10. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arc Intl Med 2007; 167(13):1414-9.
11. Wiedermann CJ, Stockner I. Warfarin-induced bleeding complications – clinical presentation and therapeutics options. Thrombs Res 2008; 122 Suppl 2:S13-8.
12. ISMP. Instituto para Práticas Seguras no Uso de Medicamentos. Uso seguro de anticoagulantes orais de ação direta - Lista atualizada 2020 [Internet]. Boletim ISMP Brasil. 2020, ISSN:2317-2312, vol. 9, nº1. [cited 2025 Mar 05] Available from: https://www.ismp-brasil.org/site/wp-content/uploads/2020/03/boletim_anticoagulantes_orais_de_acao_direta.pdf.
13. Flores LFL. Educação para o uso de terapia anticoagulante oral com varfarina em pacientes internados em hospital universitário terciário: avaliação de conhecimento prévio e variáveis relacionadas [tese]. Porto Alegre: Universidade Federal do Rio Grande do Sul; 2017. [cited 2025 Mar 05] Available from: https://lume.ufrgs.br/handle/10183/178647. Portuguese.
14. Telles JS, Fukuda EY, Feder D. Warfarin: pharmacological profile and drug interactions with antidepressants. Einstein 2012; 10(1):110 115.
15. BRASIL. Ministério da Saúde. Portaria nº 2.510, de 19 de dezembro de 2005. [cited 2025 Mar 05] Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2005/prt2510_19_12_2005.html.16. US, Department of Health and Human Services Office of Disease Prevention and Health Promotion. National action plan for adverse drug event prevention. [cited 2025 Mar 05] Available from: https://odphp.health.gov/sites/default/files/2019-09/ADE-Action-Plan-508c.pdf.
17. Natali BJ, Varkey AC, Garey KW, Liebl M. Impact of a pharmacotherapy alerting system on medication errors. Am J Health Syst Pharm 2013; 70(1):48-52.
18. Falconer N, Nand S, Liow D, Jackson A, Seddon M. Development of an electronic patient prioritization tool for clinical pharmacist
interventions. Am J Health Syst Pharm 2014; 71(4):311-20.
19. Caetano R, Silva AB, Guedes ACCM, Paiva CCN, Ribeiro GR, Santos DL, Silva RM. Challenges and opportunities for telehealth during
the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context. Cad Saúde Pública 2020; 36(5):e00088920.
20. Ravn-Nielsen LV, Duckert ML, Lund ML, Henriksen JP, Nielsen ML, Eriksen CS, Buck TC, Pottegård A, Hansen MR, Hallas J. Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission: A Randomized Clinical Trial. JAMA Intern Med 2018; 178(3):375-382.
21. Ferracini FT, Almeida SM, Locatelli J, Petriccione S, Haga CS. Implementation and progress of clinical pharmacy in the rational medication use in a large tertiary hospital. Einstein 2011; 9(4):456-60.
22. Fideles GMA, Alcantara-Neto JM, Peixoto Júnior AA, Souza-Neto PJ, Tonete TL, Silva JEG, Silva JEG, Neri EDR. Pharmacist recommendations in an intensive care unit: three-year clinical activities. Rev Bras Ter Intensiva 2015; 27(2):149-154.
23. Medeiros RDA, Moraes JP. [Pharmaceutical interventions in medical prescriptions in the Intensive Care Unit]. Rev Bras FarmHosp Serv Saúde 2017; 8(3): 25- 30. Portuguese.
24. Nácul MP, Fonseca MK, Sommer R. [The hidden side of the coronavirus tragedy]. Rev Col Bras Cir 2020; 47:e20202619. Portuguese.
25. Simonetti SH, Faro ACM, Bianchi ERF. Adherence Score for Users of Oral Anticoagulants. Int J Cardiovasc Sci 2018; 31(4)383-392.
26. Bolela F. Estado de saúde e adesão ao tratamento de pacientes atendidos em ambulatório especializado em anticoagulação oral. [tese]. São Paulo: Escola de Enfermagem de Ribeirão Preto; 2013. Available from: https://www.teses.usp.br/teses/disponiveis/22/22132/tde-26092013-193814/publico/FABIANABOLELA.pdf. Portuguese.