An Audit of a National Paediatric Cardiology Warfarin Clinic

Background: The National Cardiology Heart Centre manages the most complex cardiology conditions in Ireland leading to a large cohort of patients requiring anticoagulation. The warfarin clinic is a telephone clinic managed by the Cardiology medical team.

Aim: To audit the Warfarin Clinic using the NPSA (National Patient Safety Authority) guidelines established by the NHS for warfarin dosing.

Method: The computerized data collection of all warfarin patients was reviewed over a three month period. This revealed 54 patients on warfarin with a total of 495 INRs. Data recorded from the telephone clinic was audited under the heading of key safety indicators as outlined by the NPSA. The method of monitoring the INR was also audited by telephone when contacting parents with doses. The results were compared to the NPSA safety standards for warfarin dosing. A standard of 90% was set for each standard.

Results: 54 patients were included in the audit. 100% of patients had a documented target INR, clinical diagnosis and most recent doses recorded. No patient had a documented stop date. 69% of INR’s were in target range. 7% (N=4) had an INR of greater than 5 and no patients had an INR greater than 8. No patients had an adverse outcome. There was no process for identifying patients lost to follow up. 33% of 30 patients audited are using home ‘coagucheck’ kits with the remaining audited patients using their local hospital phlebotomy services.

Conclusion: This audit shows that there is a need to implement a computerized system of following up patients. An online calendar has been set up which documents what date patients are booked in for INR review. All new patients will now have a stop date documented. There will be a re-audit in three months’ time with the aim of improving compliance to the safety standards.