An Educational Teaching Intervention for Patients Taking Warfarin

Abstract

**Please note that the full text is embargoed** ABSTRACT: A trial fibrillation (AF) and venous thromboembolism (VTE) are serious medical disorders that require anticoagulation to prevent potential problems such as stroke and/or death. Warfarin has been the anticoagulant used for over 50 years and continues to be prescribed despite the development of novel oral anticoagulant (NOAC) agents. Many studies mention the perils associated with patients' inadequate knowledge about warfarin and highlight the importance of patient education on warfarin anticoagulation in their conclusions (Vormfelde et al., 2014). By augmenting current instructive strategies with a validated, standardized questionnaire designed to assess sustained knowledge, areas needing reinforcement were targeted. Method: For this quality improvement project, clinical outcomes were measured by international normalized ratio (INR) levels during the initial enrollment visit and again at six weeks. Cognitive outcomes focused on knowledge retention and were assessed by a questionnaire at the end of the enrollment visit and again during a face-to-face follow up visit in six weeks. A quasiexperimental design was conducted to determine if administering a questionnaire after initial individual teaching and again in six weeks had improved cognitive outcomes. In addition, clinical outcomes were tracked for consistency and compared to a matched group of patients not participating in the study to analyze whether individual, face-to face-teaching with testing using a questionnaire improved INR results. Results: None of the comparisons between baseline and six weeks for INR or number of correct responses to educational assessment questionnaires demonstrated any statistically significant difference at or above 95% Confidence (Median Test, p<0.05). However, several measurable differences in the statistical distributions of INR and test score values between the Control Group and the Intervention Group were observed. While not significant as defined, results imply clinically important contrasts between baseline and six week values. Conclusion: Findings of this quality improvement project cannot be generalized. Nonetheless, additional investigation is warranted and should be conducted to determine the optimal method for patient education. Using a validated questionnaire to evaluate knowledge retention can indicate what areas need reinforcement and assist in optimal outcomes for patients.