13 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.
EPA Template:
Note: Printable EPA templates are available to students on their 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 |
