Abstract
BACKGROUND: Current practice recommends that direct anticoagulation patients receive standardized testing using international normalized ratio (INR) with overall management of time in therapeutic range (TTR). However, disparity exists between current recommendations and clinical practice regarding decision adjustment of medications to maintain TTR. The significance is algorithms improve the TTR by improving prescribing practices and patient outcomes. The purpose of this quality improvement project was to examine the common clinical practices and outcome characteristics at an anticoagulation clinic. Out-of-range INR was assessed and compared with changes based on newly created policy using the Rosendaal method to calculate TTR.|METHODS: In 2019, 374 patients underwent laboratory testing, 135 of these patients were tested for anticoagulation management and constituted the project group. The Rosendaal method was used on individual patient’s total 2019 INR draws to identify the TTR, then an average of patient’s TTR was calculated.|RESULTS: In the year 2019, 64.7% of the patients remained within therapeutic range and 23.7% of patients followed the current policy. One hundred percent of the patients would have changes to their treatment with proposed recommendations.|CONCLUSIONS: There is a correlated increase in TTR with the implementation of TTR management and/or a policy change. Clinical use of TTR measurement with the Rosendaal method shows room for improvement in anticoagulation management. Accurate practice and documentation of protocol will improve patient’s maintenance in target INR range.|Keywords: anticoagulation, coumadin, warfarin, algorithm, primary care, TTR