Patient Engagement in Management of Warfarin: A Quality Improvement Study


      • Self-management of oral anticoagulant therapy is INR self-testing and warfarin self-dosing.
      • Self-management of oral anticoagulant therapy is recommended by the American College of Clinical Pharmacy.
      • Self-management of warfarin was as effective as provider management.
      • Self-management promotes patient engagement in behaviors that reduce the impact of their disease.


      Self-monitoring of long-term oral anticoagulant therapy has been possible since 2002. Warfarin self-dosing, although an accepted practice by the American College of Chest Physicians, is seldom offered to patients. This quality improvement study involved implementing and evaluating patient engagement in self-management of warfarin (international normalized ratio self-testing and warfarin self-dosing). This practice was found to be as safe and effective as provider management and resulted in tighter control of variance of international normalized ratio. This intervention should be offered to eligible patients because it promotes engagement in behaviors that reduce the impact of their disease and decreases the burden of care on the provider.


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      Kathleen R. Bonaventura, DNP, APRN-BC, CCEPS, CCDS, is a nurse practitioner at Cardiac Specialists, a Division of Northeast Medical Group of Yale New Haven Health Systems.


      Kerry A. Milner, DNSc, RN, is an assistant professor in the College of Nursing at Sacred Heart University in Fairfield, CT. She can be reached at [email protected].