Management of oral anticoagulation in a population of children with cardiac disease using a computerised system to support decision-making.

Full Abstract

OBJECTIVE:
To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation.

DESIGN:
Retrospective case series study comparing manual and computerised records of prescribing.

SETTING:
A tertiary paediatric cardiology department in a teaching hospital.

PARTICIPANTS:
The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making.

INTERVENTIONS:
A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians.

MAIN OUTCOMES:
We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department.

RESULTS:
We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p = 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p = 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines.

CONCLUSION:
The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.

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Author information

Author/s: Soper, Juliet (J); Chan, George T C (GT); Skinner, Jonathan R (JR); Spinetto, Heather D (HD); Gentles, Thomas L (TL);

Affiliation: Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: Cardiology in the young (Cardiol Young), published in England. (Language: eng)

Reference: 2006-Jun; vol 16 (issue 3) : pp 256-60

Dates: Created 2006/05/26; Completed 2006/08/03; Revised 2008/11/21;

PMID: 16725064, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Administration, Oral
Adolescent
Anticoagulants - administration & dosage
Child
Child, Preschool
Decision Making, Computer-Assisted
Drug Prescriptions - standards
Female

Follow-Up Studies
Heart Diseases - drug therapy
Humans
Male
Practice Guidelines as Topic
Retrospective Studies
Treatment Outcome
Warfarin - administration & dosage

Associated Chemicals: Anticoagulants (0) ; Warfarin (81-81-2)

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