Quality Improvement Initiative for Pharmacist-Assisted Warfarin Dosing: Implementation and Evaluation of a New Protocol
Bibliographic record
Abstract
Background and Objective: A Pharmacist-Assisted Warfarin Dosing (PAWD) program was implemented for patients in the cardiac program of the authors’ hospital in 1996. Within the PAWD program, certified pharmacists, under the direction of physicians, are responsible for warfarin dosing according to an approved protocol. The aim of the program was to have the international normalized ratio (INR) of at least 70% of patients within the therapeutic range at day 4 or 5 after initiation of therapy. However, a preliminary assessment showed that pharmacists were able to use the approved protocol for only 50% of the doses ordered, and only 61% of patients reached the therapeutic range by day 4. A quality improvement initiative was undertaken, and the warfarin protocol was modified. The current study reports the results of a retrospective comparison of outcomes before and after the quality improvement initiative. Methods: The authors compared outcomes for 59 patients enrolled in the PAWD program under the original protocol and 28 patients under the updated protocol. Results: Pharmacists were able to follow the updated protocol in a greater proportion of cases than had been the case with the original protocol. In addition, the mean INR was more often within the therapeutic range when the updated protocol was used, reaching statistical significance on days 5 and 6. Bleeding developed infrequently with either protocol, and vitamin K was used sparingly. Thrombosis did not occur in any patients. Conclusions: Through a continuous quality improvement process, the PAWD program was enhanced and the number of days on which INR was within the therapeutic range increased. These improvements should reduce the frequency of negative patient outcomes (e.g., adverse or thromboembolic events).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.289 | 0.232 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.004 | 0.006 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".