OUMC Anticoagulation Team
Clinical Guidelines – Warfarin
Updated: 3/04/2009
As a means of reducing the likelihood of patient harm associated with the use of anticoagulation therapy within OUMC, the OUMC Anticoagulation Team
has developed the following Clinical Guidelines for use of warfarin within OU Medical Center.
Responsible
Party
Clinical Guidelines - Warfarin
Pharmacy and
Therapeutics
Committee
1.
2.
3.
4.
Ensure that only A/B rated warfarin products are included in the Hospital formulary.
Review all adverse drug reactions associated with warfarin therapy and initiates appropriate follow-up actions.
Assures that the warfarin antagonist, Vitamin K, remains on the formulary and is available for use.
Develops MUE criteria for subsequent review/reporting through the Joint Quality Review and Medical Executive
Committees.
Medical Staff
1.
2.
3.
4.
5.
Initiates either written or electronic (ePOM) orders for warfarin using OUMC Warfarin Orders.
Specifies the indication requiring anticoagulation therapy and INR goal in the orders or medical record.
Orders a baseline PT/INR within 24 hours before initiation of therapy.
Orders PT/INR daily until the required therapeutic range has been reached and sustained for two consecutive days.
After initial dose stabilization, orders INR three times weekly [or more frequently].
Pharmacy
Nursing
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1. Ensure that only A/B rated warfarin products are stocked.
2. Ensures that only manufacturer’s unit-dose products are procured whenever available; otherwise, unit-dose and barcoded packaging is provided before warfarin is dispensed.
3. Reviews PT/INR prior to initial order entry/validation and upon subsequent changes in the medication regimen.
4. Evaluates the potential for drug-drug interactions involving warfarin.
5. Dispenses initial warfarin dose and dose modifications only if related lab results are appropriate.
6. Initiates clinical interventions with the prescriber for any deviations from these guidelines
7. Prints report daily to Nutrition Services of patients with active orders for warfarin.
8. Maintains the warfarin antagonist, Vitamin K, in the pharmacy at all times.
9. Provides additional information for educational needs on an as-needed basis.
1. Draws PT/INR as ordered by the medical staff.
2. Reviews PT/INR results prior to administration of warfarin and notifies physician as required per monitoring orders.
Responsible
Party
Clinical Guidelines - Warfarin
3.
4.
5.
6.
Administers warfarin per standardized schedule at 1800 hours daily.
Never splits warfarin tablets; uses only full tablets to achieve ordered dose.
Alerts the physician if patient exhibits signs/symptoms of bleeding or thrombosis, or falls.
Limits the use of intramuscular injections of concomitant medications to the upper extremities for patients receiving
warfarin therapy.
7. Provides education to the patient and family using OU Medical Center Patient Education Committee-approved material.
8. May initiate a dietitian or pharmacy consult if additional education is needed.
9. At discharge, reviews with patient/family members, the follow-up instructions from the physician relative to
anticoagulation medications, e.g. follow-up appointment information.
Nutrition Services
1. Reviews daily report of patients on warfarin therapy and provides education material as identified in OU Medical
Center’s Policy and Procedure #12-12 pertaining to Food:Drug Interactions.
Laboratory/Blood
Bank
1. Maintains fresh frozen plasma supply at all times for the emergent management of bleeding and excessive
anticoagulation.
Approvals:
OU Medical Center Anticoagulation Team:
OU Medical Center Medication Management Team:
OU Medical Center Pharmacy and Therapeutics Committee:
OU Medical Center Joint Quality Review Committee:
OU Medical Center Medical Executive Committee:
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