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Development of a Care Process at Sub-district Health Promotion Hospitals in Kamalasai Health District to Enhance Safety for Warfarin Patients |
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| รหัสดีโอไอ | |
| Creator | Archaree Seeha |
| Title | Development of a Care Process at Sub-district Health Promotion Hospitals in Kamalasai Health District to Enhance Safety for Warfarin Patients |
| Contributor | Kritsanee Saramunee |
| Publisher | Faculty of Pharmaceutical Sciences KKU, MSU, UBU |
| Publication Year | 2562 |
| Journal Title | Isan Journal ofPharmaceutical Sciences |
| Journal Vol. | 15 |
| Journal No. | 4 |
| Page no. | 37-49 |
| Keyword | patient care process, warfarin, primary care, action research |
| URL Website | https://tci-thaijo.org/index.php/IJPS |
| Website title | Isan Journal ofPharmaceutical Sciences,IJPS |
| ISSN | 19050852 |
| Abstract | Patients using warfarin should administer this medication carefully to prevent adverse drug reactions. However, it was recently revealed that at a sub-district health promoting hospital (SHPH) in the Kamalasai District Health Network patients were frequently prescribed medicines that could potentially interact with warfarin. Therefore, it is necessary to develop a care process for patients using warfarin in order to improve safety for these patients when they visit SHPHs. Materials and Methods: This action research study, conducted in the Kamalasai District Health Network, was divided into four steps: planning, action, observing, and reflecting. The 'planning' step involved collecting data from various stakeholders to establish a care process for SHPHs. Participants included fifteen patients using warfarin, ten prescribers at the SHPH, and five health staff members at the Kamalasai Hospital warfarin clinic. The 'action' step involved the official implementation of an agreement regarding the care process for all SHPHs within the health network. The 'observing' step involved quantitative data collection comparing pre- vs. post-study incidence of prescribing drugs that potentially interact with warfarin, and a pre-/post-assessment of a participant's knowledge of the safe use of warfarin. In the 'reflecting step' all participants shared their opinions on the modified care process. Participants also documented changes in their knowledge, awareness, and practices when prescribing medication to warfarin patients. Results: The care process included multiple components such as the use of alerting tools, guidelines for medicine use, protocols for referring patients experiencing complications, and continuous contact between researcher and SHPH prescribers to ensure adherence to care protocol. Quantitative analysis indicated a trend toward decreased frequency of inappropriate prescription of potential warfarin-interacting drugs, from 1.6% to 1.4%, but this was not statistically significant (p = 0.906). Enhancement of the education of SHPH prescribers regarding warfarin (n = 36) did significantly increase from 7.9 ? 0.8 to 9.9 ? 0.9 (p < 0.001; maximal score = 11). Reflection revealed that participants had more confidence in patient care and an elevated awareness concerning the safety of multi-drug administration to patients using warfarin. Conclusion: A modified process for providing care at SHPHs for patients using warfarin did not significantly reduce the frequency with which drugs were prescribed that could adversely interact with warfarin. However, providing SHPH prescribers with a better understanding of the concerns regarding the use of warfarin is expected to increase safety for patients taking warfarin. |
