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Management of oral anticoagulation in a population of children with cardiac disease using a computerised system to support decision-making

Published online by Cambridge University Press:  26 May 2006

Juliet Soper ,
George T.C. Chan ,
Jonathan R. Skinner ,
Heather D. Spinetto  and
Thomas L. Gentles
Juliet Soper
Affiliation:
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
George T.C. Chan
Affiliation:
Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
Jonathan R. Skinner
Affiliation:
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
Heather D. Spinetto
Affiliation:
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
Thomas L. Gentles
Affiliation:
Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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Abstract

Objective: To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation. Design: Retrospective case series study comparing manual and computerised records of prescribing. Setting: A tertiary paediatric cardiology department in a teaching hospital. Participants: The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making. Interventions: A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians. Main outcomes: We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department. Results: We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines. Conclusion: The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.

Keywords

WarfarinFontan circulationInternational Normalised Ratio
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 3 , June 2006 , pp. 256 - 260
Copyright
© 2006 Cambridge University Press

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