The safety of warfarin therapy in the nursing home setting
The safety of warfarin therapy in the nursing home setting
复制标题
DOI：
10.1016/j.amjmed.2006.07.045
复制
发表时间：
2007-06-01
影响因子：
5.9
通讯作者：
Verzier, Nancy
中科院分区：
文献类型：
--
作者：
Gurwitz, Jerry H.;Field, Terry S.;Verzier, Nancy
目的：我们检查了疗养院中华法林相关不良事件和潜在华法林相关不良事件（“未遂事件”）的可预防性。 方法：我们在 12 个月的观察期内对康涅狄格州 25 家疗养院（床位大小范围为 90-360）的所有长期护理居民进行了队列研究。每季度这些设施中的居民总数为 2,946 至 3,212 人。有 490 名居民接受了华法林治疗。由训练有素的护士提取员每季度对疗养院记录进行回顾性审查，发现可能与华法林相关的事件。每个事件均由 2 名医师审查员独立分类，以确定其是否构成华法林相关事件、其严重程度及其可预防性。主要结局是华法林相关不良事件，定义为与使用华法林相关的损伤。华法林相关潜在不良事件被定义为国际标准化比值 (INR) 为 4.5 或更高、发现管理错误但未发生伤害的情况。我们还评估了疗养院住院医师每天在特定 INR 范围内使用华法林的时间。 结果：在 12 个月的观察期内，发现了 720 起华法林相关不良事件和 253 起潜在华法林相关不良事件。在与华法林相关的不良事件中，625 例 (87%) 被认为是轻微的，82 例 (11%) 被认为是严重的，13 例 (2%) 被认为是危及生命或致命的。总体而言，29% 的华法林相关不良事件被认为是可以预防的。严重、危及生命或致命事件的发生率为每 100 个住院月 2.49 起；这些更严重的事件中有 57% 被认为是可以预防的。导致可预防事件的错误最常发生在华法林管理的处方和监测阶段。 INR 低于 2、2 至 3 和高于 3 范围的时间百分比分别为 36.5%、49.6% 和 13.9%。结论：在疗养院环境中使用华法林会给患者带来重大安全问题。与华法林治疗相关的不良事件很常见，并且在疗养院环境中通常是可以预防的。预防策略应针对华法林管理的处方和监测阶段。 (c) 2007 Elsevier Inc. 保留所有权利。
PURPOSE: We examined the preventability of adverse warfarin-related events and potential adverse warfarin-related events ("near misses") in the nursing home setting.METHODS: We performed a cohort study of all long-term care residents of 25 nursing homes (bed size range, 90-360) in Connecticut during a 12-month observation period. The total number of residents in these facilities ranged from 2946 to 3212 per quarter. There were 490 residents who received warfarin therapy. Possible warfarin-related incidents were detected by quarterly retrospective review of nursing home records by trained nurse abstractors. Each incident was independently classified by 2 physician-reviewers to determine whether it constituted a warfarin-related event, its severity, and its preventability. The primary outcome was an adverse warfarin-related event, defined as an injury associated with the use of warfarin. Potential adverse warfarin-related events were defined as situations in which the international normalized ratio (INR) was noted to be 4.5 or greater, an error in management was noted, but no injury occurred. We also assessed time in specified INR ranges per nursing home resident day on warfarin.RESULTS: Over the 12-month observation period, 720 adverse warfarin-related events and 253 potential adverse warfarin-related events were identified. Of the adverse warfarin-related events, 625 (87%) were characterized as minor, 82 (11%) were deemed serious, and 13 (2%) were life-threatening or fatal. Overall, 29% of the adverse warfarin-related events were judged to be preventable. Serious, life-threatening, or fatal events occurred at a rate of 2.49 per 100 resident-months; 57% of these more severe events were considered preventable. Errors resulting in preventable events occurred most often at the prescribing and monitoring stages of warfarin management. The percentages of time in the less than 2, 2 to 3, and more than 3 INR ranges were 36.5%, 49.6%, and 13.9%, respectively.CONCLUSIONS: The use of warfarin in the nursing home setting presents substantial safety concerns for patients. Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting. Prevention strategies should target the prescribing and monitoring stages of warfarin management. (c) 2007 Elsevier Inc. All rights reserved.