Authors (including presenting author) :
CHU LMP(1)(3), CHIU PL(1)(4), HAU LM(1)(2), KWOK YT(1)(2), LAM MS(1)(4), LEUNG PMQ(4), NG TFA(1)(3), SHING LY(1)(2), WONG PMB(1)(2), YUEN CL(1), YUNG LJ(1)(3)
Affiliation :
(1) Medication Safety Committee, NTWC
(2) Quality & Safety Division, NTWC
(3) Department of Pharmacy, NTWC
(4) Nursing Services Division, NTWC
Introduction :
Warfarin, a high-alert medication, is associated with a high risk on medication safety due to its complex prescription patterns and narrow therapeutic range. In New Territories West Cluster (NTWC), Warfarin is commonly prescribed using an unscheduled medication order, such as "once per day", in the electronic In-patient Medication Order Entry system, in which medication orders with an unscheduled frequency would require nurses to perform manually scheduling of frequency and administration time. This manual process was prone to error due to slip and inattention. Therefore, NTWC launched a campaign to eliminate the need for manual frequency setting by changing the prescribing behaviour to medication orders with scheduled frequency.
Objectives :
To change the prescribing behaviour of Warfarin from unscheduled to scheduled frequency and minimise the risk in manual scheduling.
Methodology :
NTWC Medication Safety Committee collaborated with Pharmacy Department to review past Warfarin prescriptions. An initiative was the proposed to standardise the use of "PM" (scheduled frequency) instead of "once per day" (unscheduled frequency)
Result & Outcome :
The initiative was supported by NTWC Drug and Therapeutics Committee, MSC, and Nursing Management Committee. In November 2024, medical staff were informed of this practice via department meetings and email. As >90% of Warfarin prescriptions were managed by Warfarin Clinic, Pharmacy supported instructing patients to take Warfarin in the afternoon in inpatient and outpatient settings. Pharmacy Department also reviewed and contacted doctors who prescribed Warfarin with an unscheduled frequency to revise their prescriptions.
The impact of these changes was evident. In outpatient setting, Warfarin prescriptions using "PM" (scheduled frequency) increased from 13 in October 2024 to 859 in December 2024 (↑6508%), while "once per day" (unscheduled frequency) decreased from 1,032 to 136 (↓87%). In inpatient setting, "PM" prescriptions increased from 53 to 326 (↑515%), while "once per day" decreased from 362 to 163 (↓55%) in the same period. There was no incident related to wrong frequency setting in this period.
The initiative successfully standardized Warfarin prescriptions, reduced complexity, minimised the requirement for manual scheduling and significantly improved medication safety through interdisciplinary collaboration.
