Randomized trial of a warfarin communication protocol for nursing homes: an SBAR-based approach.
Randomized trial of a warfarin communication protocol for nursing homes: an SBAR-based approach.
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DOI：
10.1016/j.amjmed.2010.09.017
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发表时间：
2011-02
影响因子：
5.9
通讯作者：
Gurwitz, Jerry H.
中科院分区：
文献类型：
--
作者：
Field, Terry S.;Tjia, Jennifer;Mazor, Kathleen M.;Donovan, Jennifer L.;Kanaan, Abir O.;Harrold, Leslie R.;Reed, George;Doherty, Peter;Spenard, Ann;Gurwitz, Jerry H.
目前，超过160万美国人住在养老院。多达12%的患者接受华法林长期抗凝治疗。先前的研究已经证明了华法林治疗在这种情况下存在安全性问题的令人信服的证据，通常与疗养院工作人员和处方医生之间的沟通不佳有关。2007-2008年，我们在康涅狄格州的26家疗养院进行了一项华法林管理协议的随机试验，护士和医生之间使用方便的电话沟通。干预机构采用“情况、背景、评估和建议”（SBAR）方法接受华法林管理沟通方案。该方案包括一个SBAR模板，通过要求有关触发呼叫的情况、背景、护士的评估和建议的信息，标准化关于华法林住院医师的电话沟通。在研究期间，435名居民在干预家庭中接受了55，167天的华法林治疗，在对照家庭中接受了53，601天的华法林治疗。干预组住院患者的国际标准化比值（INR）值在治疗范围内的时间比对照组多4.50%（95% CI，0.31%，8.69%）。INR值≥4.5后3天内获得随访INR的情况无差异（OR 1.02（95% CI，0.44，2.4））。干预家庭中可预防的华法林相关不良事件发生率较低，尽管该结果无统计学意义：任何可预防的华法林相关不良事件的发生率比为0.87（CI，0.54，1.4）。便利的护士和医生之间的电话沟通，使用SBAR方法适度提高华法林管理的护理之家居民的质量。
More than 1.6 million Americans currently reside in nursing homes. As many as 12% receive long-term anticoagulant therapy with warfarin. Prior research has demonstrated compelling evidence of safety problems with warfarin therapy in this setting, often associated with suboptimal communication between nursing home staff and prescribing physicians. We conducted a randomized trial of a warfarin management protocol using facilitated telephone communication between nurses and physicians in 26 nursing homes in Connecticut in 2007–2008. Intervention facilities received a warfarin management communication protocol using the approach “Situation, Background, Assessment, and Recommendation” (SBAR). The protocol included an SBAR template to standardize telephone communication about residents on warfarin by requiring information about the situation triggering the call, the background, the nurse’s assessment and recommendations. 435 residents received warfarin therapy during the study period for 55,167 resident days in the intervention homes and 53,601 in control homes. In intervention homes, residents’ international normalized ratio (INR) values were in the therapeutic range a statistically signiciant 4.50% more time than in control homes (95% CI, 0.31%, 8.69%). There was no difference in obtaining a follow-up INR within 3 days after an INR value ≥4.5 (OR 1.02 (95% CI, 0.44, 2.4). Rates of preventable adverse warfarin-related events were lower in intervention homes, although this result was not statistically significant: the incident rate ratio for any preventable adverse warfarin-related event was .87 (CI, .54, 1.4). Facilitated telephone communication between nurses and physicians using the SBAR approach modestly improves the quality of warfarin management for nursing home residents.
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影响因子：
5.4
作者：
Schmidt, IK;Svarstad, BL
通讯作者：
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影响因子：
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作者：
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通讯作者：
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作者：
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影响因子：
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作者：
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DOI：
10.1197/jamia.m2955
发表时间：
2009-03-01
影响因子：
6.4
作者：
Resnick, Helaine E.;Manard, Barbara B.;Alwan, Majd
通讯作者：
Alwan, Majd