Patients need better anticoagulation therapy education

[jbowers]

Hi

Have any of you noticed that patients are lacking education on anticoagulation? Is academia not teaching anticoagulation to nurses, expecially in the ADN programs? Does your hospital have a pharmacists do patient teaching on Warfarin/Coumadin or does the nurse do the teaching in your institution? Are your pharmacists consistent with the consulting or is it a hit and miss situation? How concerned are you regarding patient safety with those patients on anticoagulation therapy (AT) after discharge? I have just noticed this problem is ongoing and trying to figure out if this is a common problem in other hospitals in the US (and UK) or if this dysfunction is present within my health care area.

I have worked in an anticoagulation clinic for several years and it is so disheartening that patients are not getting the education they need prior to hospital discharge and when we see them at the clinic. We have over 1000 Coumadin patients and scheduling these patients gets tight. This interim period of 2-4 days can be critical in patient care and safety. I just believe if patients had more education before leaving the hospital they would be safer at home until followed up at the clinic.

Thanks for sharing your thoughts

[purple10]

depends on the facility.

[Altra, BSN, RN]

What education do you find that your patients are lacking?

I live in an area with a large elderly population ... and thus a large Coumadin patient population. Education is generally done by nurses and physicians.

[Nurse_Hagatha]

I always tell patients, "If you don't hear anything else I tell you about coumadin, just remember it is a very dangerous drug that requires close monitoring." Oh, and I came from an ADN program.

[morte, LPN, LVN]

less time in hospital=less time to educate.

[7Jkm7]

Sadly, many professionals doing the educating are woefully out of date themselves.

It's hard to believe but true that some 'educators' are still saying patients cannot shave with a razor blade, they ban all green leafy vegetables, forbid a drink or glass or wine, they don't understand gradual dose changes and put patients on roller coaster of too high, too low because of their holding doses or increasing too much.

Consistency in diet and exercise is so much more important than precisely what is in the diet. If someone loves broccoli, they should not be told to give it up when prescribed coumadin, they should be told to be consistent in how much and how often they eat it. Vitamin K in the diet seems to keep patients in range more than those who totally avoid any Vitamin K. One must be consistent, however.

They can have a glass of wine with dinner..... if they often have a glass of wine with dinner.

Patients will continue to be confused about coumadin as long as the professionals remain confused. IMO

More education is the key for both groups, of course.

[nursej22, MSN, RN]

Due to cutbacks recommended by a consultant group, our pharmacists rarely do any patient education. It falls to the nurse who will grab a brochure from the ed cupboard to give to the patient. I seldom have time to completely review the info what with have to fix TVs, find chairs for visitors, give directions to motels, call cabs, etc.

The doctors also do some education, unfortunately patients tell me they have trouble understanding due to strong accents.

The retail pharmacist is also a good source education and they will usually offer if this is a new med.

I find for the most part, that returning patients are very knowledgeable about their warfarin. Those that come in with an INR of 8 are usually elderly, have some dementia and other co-morbidities that make titration difficult.

[MrChicagoRN, RN]

Most of our patients went home on Coumadin, Lovenox, or Fragmin

Pt teaching was definitely an expectation for the nurses.

[xtxrn, ASN, RN]

I got a drug info handout, a list of foods high in vit K, and reinforcement that I needed to be alert to all signs of bleeding- acute, chronic, new or old. That was it. Had I been illiterate, I would have been SOL.

Nurses who do not deal with warfarin (in particular) regardless of educational background (BSNs don't own the patient teaching award- nurses with specific experience and the desire to give complete care w/patient education get my vote with that :)) don't know a lot about warfarin. I knew the basics...but until I had to take the stuff (22 years after becoming an RN) I didn't know the massive effect it has on other meds, the consistent vit K intake, not eating cranberries, etc....

This was in 2007.

[LouisVRN, RN]

When we have a patient leaving on Warfarin as a new medication we are required to do teaching along with dietary and pharmacy who do separate teaching.

[nurseprnRN, BSN, RN]

oooh, hot button.

:idea:start with banning the words "blood thinner" from any and all conversations. it puts the lay person in mind of water in the milk, or turpentine in the paint, and that is sooooo wrong. besides, the patient needs to understand this is all about clotting, and that's got nothing to do c "thick." explain that to them what "coagulation" and "anticoagulation" mean-- "clotting" and "decreased clotting."

[BacktoBasics]

Sadly, many professionals doing the educating are woefully out of date themselves.

It's hard to believe but true that some 'educators' are still saying patients cannot shave with a razor blade... quote]

What's the change with this? I graduated nursing school like 4 years ago and I still learned it...