51 Oral Anticoagulant Education
Outcomes:
Accurate and individualised education for patients initiated on oral anticoagulant medication allowing them to use the medicine safely and appropriately.
Potential Risks:
Inaccurate or incomplete provision of information can lead to inappropriate use of the medication, potentially leading to patient harm.
Course
This EPA is undertaken in PHRM4071, PHRM4072 or PHRM4062.
Entrustment level
The anticipated entrustment level for PHRM4071, PHRM4072 or PHRM4062 is 2-3.
EPA Template:
Note: Printable EPA templates are available on course sites.
| Element | Performance Criteria Description |
|---|---|
| Introduction to consultation | - Greet patient, establish patient identity, confirm time is convenient - Provide clear introduction to consultation, explaining your role and purpose of the consultation |
| Patient Background | - Assess patient’s ability to read written information, and provide suitable resources in advance e.g. warfarin or DOAC booklet, CMI - Assess need for carer/translator to be present at time of education - Verify indication of oral anticoagulation, target INR (warfarin only) and predicted treatment duration - Consider any relevant clinical factors e.g. choice of anticoagulation, dose, compliance, patient age, weight, renal function, risk of bleeding, precautions and contraindications, drug interactions, plan for monitoring and follow up |
| Patient Education and Communication Technique | - Assess patient’s baseline or prior knowledge and experience with oral anticoagulation (if any) - Explain indication and goal of oral anticoagulation specific to patient’s condition (including need for bridging therapy if applicable e.g. enoxaparin) - Explain likely duration of therapy - Uses a balance of open and close-ended questions to obtain relevant information in a logical order - Uses appropriate language (i.e. non-judgmental, non-alarmist, jargon-free, reassuring) - Speak using appropriate tone, volume and speed - Demonstrate sensitivity to specific cultural/social needs and beliefs of the patient - At the end of session, summarise key points and provide opportunity for questions |
| Warfarin Only Information | - Explain that existing brands Marevan® and Coumadin® are NOT interchangeable - Specify patient’s brand - Explain the importance and meaning of INR in layman terms - Inform patient of their target INR - Discuss regularity of blood tests and explain procedure if INR is too high or too low - Encourage patient to record INR and dose, highlight section in booklet - Identify follow-up plan for INR monitoring on discharge and ongoing in the community - Discuss the need to plan INR testing around travel - Discuss food interactions and the importance of a regular, consistent, balanced diet |
| Dosing | - Discuss frequency of dosing, select a consistent and convenient time to administer - Discuss importance of regular dosing, including what to do in the event of missed doses - Warfarin only - Explain why each patient will have a unique dose (and how this relates to INR) - Warfarin only - Assess patient’s ability to calculate dose utilising multiple strength tablets |
| Drug Interactions | - Discuss potential interactions with other medications (including NSAIDs, OTC, complementary medicines), recommend safer alternatives if applicable e.g. analgesia - Advise patient to always check with doctor or pharmacist before starting any other medications including OTC and complementary medicines |
| Pregnancy or Breastfeeding | - If woman is of childbearing age, advise patient to discuss with doctor if planning to conceive - Assess current contraception and provide education around need for appropriate contraception - If breastfeeding, provide relevant information (and then discuss above) |
| Adverse Effects | - Discuss risks of bleeding - Educate on how to monitor for signs and symptoms of obvious and less obvious bleeding as well as action plan to address these - Discuss ways to reduce the risk of falls (e.g. non-slip bathmats, avoiding ladders) - Discuss any other relevant adverse effects |
| Other Health Professionals | - Highlight importance of informing other health professionals about concurrent oral anticoagulation treatment (e.g. specialists, locum doctors, dentists, surgeons), especially if scheduled for surgical procedures including dental work - Inform patients of potential requirement to temporarily cease anticoagulant prior to surgery (should be discussed with doctor) |
| Supply of Medication and Information | - Provide adequate supply of medication and suitable resources (e.g. warfarin or DOAC booklet) - Discuss ongoing supply and relevant costs |
| Collaboration and Agency | - Clarification is sought for any concerns identified and escalated to an appropriate stakeholder - Identify and acknowledge any professional or personal limitations and seek support where necessary - Consultation is conducted in a professional, efficient and respectful manner |
