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dc.contributor.authorField, Terry S.
dc.contributor.authorTjia, Jennifer
dc.contributor.authorMazor, Kathleen M.
dc.contributor.authorDonovan, Jennifer L.
dc.contributor.authorKanaan, Abir O.
dc.contributor.authorHarrold, Leslie R.
dc.contributor.authorReed, George W.
dc.contributor.authorDoherty, Peter
dc.contributor.authorSpenard, Ann
dc.contributor.authorGurwitz, Jerry H.
dc.date2022-08-11T08:09:21.000
dc.date.accessioned2022-08-23T16:27:45Z
dc.date.available2022-08-23T16:27:45Z
dc.date.issued2011-02-01
dc.date.submitted2011-03-07
dc.identifier.citationAmerican Journal of Medicine. 2011 Feb;124(2):179.e1-7.
dc.identifier.issn1555-7162
dc.identifier.pmid21295198
dc.identifier.urihttp://hdl.handle.net/20.500.14038/36858
dc.description.abstractBACKGROUND: 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).
dc.language.isoen_US
dc.publisherExcerpta Medica
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=21295198&dopt=Abstract">Link to article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.amjmed.2010.09.017
dc.subjectWarfarin
dc.subjectNursing Homes
dc.subjectClinical Protocols
dc.subjectCommunication
dc.subjectPatient Care Management
dc.subjectLong-Term Care
dc.subjectHealth Services Research
dc.titleRandomized Trial of a Warfarin Communication Protocol for Nursing Homes: an SBAR-based Approach.
dc.typeJournal Article
dc.source.journaltitleThe American journal of medicine
dc.source.volume124
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/232
dc.identifier.contextkey1854184
html.description.abstract<p>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.</p> <p>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.</p> <p>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).</p> <p>CONCLUSION: Facilitated telephone communication between nurses and physicians using the SBAR approach modestly improves the quality of warfarin management for nursing home residents.</p> <p>(Registered on ClinicalTrials. gov; URL:http://clinicaltrials.gov/. Registration number: NCT00682773).</p>
dc.identifier.submissionpathmeyers_pp/232
dc.contributor.departmentMeyers Primary Care Institute
dc.source.pages179.e1-179.e7


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