Skip to main content
Article
Randomized Trial of a Warfarin Communication Protocol for Nursing Homes: an SBAR-based Approach.
Meyers Primary Care Institute Publications and Presentations
  • Terry S. Field, University of Massachusetts Medical School
  • Jennifer Tjia, University of Massachusetts Medical School
  • Kathleen M. Mazor, University of Massachusetts Medical School
  • Jennifer L. Donovan, Massachusetts College of Pharmacy and Health Sciences
  • Abir O. Kanaan, Massachusetts College of Pharmacy and Health Sciences
  • Leslie R. Harrold, University of Massachusetts Medical School
  • George W. Reed, University of Massachusetts Medical School
  • Peter Doherty, University of Massachusetts Medical School
  • Ann Spenard, Qualidigm, Inc.
  • Jerry H. Gurwitz, University of Massachusetts Medical School
UMMS Affiliation
Meyers Primary Care Institute
Date
2-1-2011
Document Type
Article
Medical Subject Headings
Warfarin; Nursing Homes; Clinical Protocols; Communication; Patient Care Management; Long-Term Care
Abstract
BACKGROUND: More than 1.6 million Americans currently reside in nursing homes. As many as 12% of them 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. METHODS: 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. RESULTS: There were 435 residents who 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 significant 4.50% more time than in control homes (95% confidence interval [CI], 0.31%-8.69%). There was no difference in obtaining a follow-up INR within 3 days after an INR value greater than or equal to 4.5 (odds ratio 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 (95% CI, .54-1.4). CONCLUSION: Facilitated telephone communication between nurses and physicians using the SBAR approach modestly improves the quality of warfarin management for nursing home residents. (Registered on ClinicalTrials. gov; URL:http://clinicaltrials.gov/. Registration number: NCT00682773).
Rights and Permissions
Citation: American Journal of Medicine. 2011 Feb;124(2):179.e1-7.
Related Resources
Link to article in PubMed
PubMed ID
21295198
Citation Information
Terry S. Field, Jennifer Tjia, Kathleen M. Mazor, Jennifer L. Donovan, et al.. "Randomized Trial of a Warfarin Communication Protocol for Nursing Homes: an SBAR-based Approach." Vol. 124 Iss. 2 (2011) ISSN: 1555-7162
Available at: http://works.bepress.com/jennifer_donovan/6/