Effectiveness of Nurse-led Warfarin Educational Programme on Knowledge and Compliance for Patients Newly Commenced on Warfarin Therapy
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Abstract
Introduction: An effective warfarin educational programme is needed in view of the recent increase in warfarin prescriptions and adverse drug events. Due to the obvious risks of anticoagulants administration, evaluating patients’ awareness seems to be crucial. This study aimed to evaluate the effectiveness of a nurse-led warfarin education program on knowledge and compliance among patients newly commenced on warfarin therapy. Methods: This study utilised the one-group pre/post-test quasi-experimental approach. A total of 64 stable patients who recently started their prescriptions on warfarin for less than six months were recruited via purposive sampling at a tertiary hospital in Kuala Lumpur, Malaysia. The nurse-led intervention consisted of structured warfarin education. Data collection using Anticoagulation Knowledge Assessment and Morisky Medication Adherence Scale to measure knowledge and compliance with warfarin therapy. Results: The mean (SD) knowledge score was 42.58 (13.18) before intervention and increased to 68.91 (17.10) after warfarin educational intervention, while the mean (SD) compliance score was 3.78 (1.76) and decreased to 3.39 (1.51) after intervention. It shows that patients’ knowledge and compliance with warfarin therapy have also improved. There was a significant association between knowledge and compliance variables (P < .001) after intervention. Conclusion: Our findings revealed that a nurse-led warfarin educational program could effectively increase patients’ anticoagulation knowledge and also improve their adherence to warfarin therapy. Hence, the study suggests implementing this intervention among a larger sample and poorly literate patients as a way to help them and increase the tendency to prevent warfarin complications.
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h design renders it impractical for any conclusions about the association between an intervention and a particular result. Furthermore, due to time constraints, this study could only proffer short-term follow-up among patients. Alternately, long-term follow-up with more patients may be advantageous in investigating the predictive effect of study characteristics and the predictors of knowledge and compliance associated with warfarin therapy.
CONCLUSION
In line with the current increase in patients on warfarin therapy, the need for an efficient warfarin education programme has become more apparent. In conclusion, an educational programme using slideshows as an audio-visual aid supplement was deemed effective in improving the quality of life among patients and encouraging compliance with warfarin therapy. Warfarin educational programme was shown to significantly increase knowledge and improve compliance. The effect of the intervention was the result of combined educational intervention approaches used in this study, which used a slideshow presentation and patient-centred information sessions. Patient education on oral anticoagulation will continue to serve as a positive change for patients and the nursing staff.
Relevance to clinical practice: This important finding will allow healthcare providers especially nurses to assess of patients’ adherence to warfarin therapy in case of poor INR control and when the prescribed treatment seems to have failed. Nurses must recognize the signs of warfarin toxicity so they can inform the doctor in charge. By providing a special counselling room to identify specific barriers for each patient and address their learning needs can be solved by adopting appropriate techniques to improve medication adherence. Hence, workshops or any training programs should be created to help healthcare providers especially nurses’ understand the potential psychological and physical side effects of anticoagulant therapy and to help them establish preventative measures. Future research could developed education via mobile technologies on enhancing warfarin therapy adherence and explore the involvement of patients’ relatives in medication adherence.
ACKNOWLEDGEMENTS
The authors are grateful to the patients at the hospital for their participation in the study. Heartfelt gratitude is also conveyed to the Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, for their sound advice and the grant awarded to embark on this study. This work was supported by the University of Malaya, Malaysia [PPP P0100/2012A].
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