Article | 10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden | Improving Warfarin Treatment: A Study Using the Six Sigma Methodology

Title:
Improving Warfarin Treatment: A Study Using the Six Sigma Methodology
Author:
Svante Lifvergren: Hospital Group of Skaraborg, Sweden Alexander Chakhunashvili: Hospital Group of Skaraborg, Sweden Bo Bergman: Chalmers University of Technology, Sweden
Download:
Full text (pdf)
Year:
2007
Conference:
10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden
Issue:
026
Article no.:
032
No. of pages:
8
Publication type:
Abstract and Fulltext
Published:
2008-02-15
Series:
Linköping Electronic Conference Proceedings
ISSN (print):
1650-3686
ISSN (online):
1650-3740
Publisher:
Linköping University Electronic Press; Linköpings universitet


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Warfarin is an oral anticoagulant (blood thinning) medication effective for the prevention and treatment of thromboembolic events in various clinical contexts; see Hylek and Singer (1994); Cannegieter et al. (1995); Odén and Fahlén (2002) and Levine et al. (2004) for more information about warfarin treatment. Since it is an extremely safety-critical medication; patients undergoing warfarin treatment should be monitored frequently by blood testing to ensure that the treatment yields desired results.

There are about 100 000 patients (approximately one percent of the total population) treated using anticoagulant medications such as warfarin today in Sweden. The proportion of older patients (over 80 years old) has increased over the past decade and today it accounts for approximately 30 percent; see Läkemedelsverket (2006). There are reasons to believe that both the proportion of patients undergoing warfarin treatment and proportion of older patients will continue to increase at the same time as alternative treatment methods; possibly replacing warfarin do not seem to appear in the near future.

The improvement project presented in this paper was conducted at a unit responsible for warfarin treatment at Lidköping hospital in Sweden. The unit coordinates and monitors the warfarin treatment of 1200 patients and consists of a cardiologist and five specially trained nurses. Lidköping hospital is situated in the Western Region of Sweden and is one of the four hospitals in the Skaraborg Group of Hospitals. It serves a population of around 85 000; and is an acute hospital having complete departments and with staff on-call. The care offered includes; among others; internal medicine; surgery; urology; orthopaedics; gynaecology and paediatrics. In total there are more than 160 beds and around 700 employees.

In the following sections we will provide the background of the study including the outline and context of the problem; assessment of the problem and strategy for change including the approach taken and recommendations proposed. Finally; we present the results of the study and elaborate on some of the lessons learned.

Keywords: Warfarin treatment; INR; Six Sigma; process improvement

10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden

Author:
Svante Lifvergren, Alexander Chakhunashvili, Bo Bergman
Title:
Improving Warfarin Treatment: A Study Using the Six Sigma Methodology
References:

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Hylek E.M. and Singer D.E. (1994); Risk factors for intracranial hemorrhage in outpatients taking warfarin; Ann Intern Med;120:897‚Äď902.


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Läkemedelsverket (2006). Rapport 1:2006.


Levine M.N.; Raskob G.; Beyth R.J.; Kearon C.; Schulman S. (2004); Hemorrhagic Complications of Anticoagulant Treatment: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Theraphy; Chest;126:287‚Äď310.


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Od√©n A. and Fahl√©n M. (2002); Oral anticoagulation and risk of death: a medical record linkage study; BMJ;325:1073‚Äď5.


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10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden

Author:
Svante Lifvergren, Alexander Chakhunashvili, Bo Bergman
Title:
Improving Warfarin Treatment: A Study Using the Six Sigma Methodology
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