DCW145-Safe Management of Warfarin and Anticoagulant Therapy Policy

Registration Number: {{org_field_registration_no}}

Safe Management of Warfarin and Anticoagulant Therapy Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} maintains a safe, effective, and compliant approach to managing warfarin and other anticoagulant therapies for service users receiving domiciliary care. Anticoagulant medications, including warfarin, rivaroxaban, apixaban, dabigatran, and edoxaban, are high-risk medicines that require careful monitoring, administration, and documentation to prevent serious complications such as excessive bleeding or clot formation.

This policy ensures compliance with the Regulation and Inspection of Social Care (Wales) Act 2016 (RISCA), the National Institute for Health and Care Excellence (NICE) Guidelines (NG89) on Anticoagulation Therapy, and the Care Inspectorate Wales (CIW) regulations regarding medication management and safe care practices.

2. Scope

This policy applies to:

All staff members, including care workers, senior care staff, and managers, who may assist in monitoring, recording, or administering anticoagulant therapy.
Service users who are prescribed warfarin or other anticoagulants and receive domiciliary support.
Healthcare professionals and third parties involved in anticoagulation monitoring, including GPs, pharmacists, and specialist anticoagulation clinics.

3. Understanding Anticoagulant Therapy Risks

Anticoagulant medications prevent blood clot formation but pose risks if not managed properly. Common risks include:

Excessive bleeding (e.g., nosebleeds, bruising, internal bleeding).
Clotting complications if the medication is not taken correctly.
Drug interactions with other prescribed or over-the-counter medications.
Dietary interactions (e.g., vitamin K-rich foods affecting warfarin levels).

To ensure safe and effective care, {{org_field_name}} follows a structured approach to monitoring, administration, and documentation.

4. Roles and Responsibilities

4.1 Responsibilities of Care Staff

Care staff must not make any decisions regarding warfarin dosages but are responsible for:

Ensuring the correct dose is administered as per the latest prescription or INR (International Normalised Ratio) test result.
Documenting medication administration accurately.
Observing and reporting signs of bleeding or clotting complications.
Ensuring compliance with GP or specialist instructions.
Monitoring for potential side effects and seeking urgent medical attention if required.

4.2 Responsibilities of the Registered Manager

The Registered Manager ensures that:

Staff receive training on anticoagulant therapy and safe medication management.
Protocols are in place for obtaining and recording INR results.
Regular audits of medication administration records (MAR) take place.
Risk assessments are carried out for all service users prescribed anticoagulants.

4.3 Responsibilities of Healthcare Professionals

GPs, pharmacists, and anticoagulation clinics are responsible for prescribing, monitoring INR levels, and adjusting dosages as necessary.
Care staff liaise with healthcare professionals if there are concerns about dosage changes, missed doses, or signs of adverse effects.

5. Safe Administration of Warfarin and Anticoagulant Therapy

5.1 Recording and Monitoring INR Levels

Warfarin dosing is based on regular INR blood tests to ensure therapeutic levels. To manage this safely:

Care staff must check the latest INR result before administering warfarin.
INR results and any dosage adjustments must be recorded immediately in care plans and MAR charts.
If an INR test is overdue, care staff must promptly inform the service user’s GP or anticoagulation clinic.

5.2 Medication Administration Guidelines

Warfarin must always be administered according to the latest prescription or INR test result.
Staff must never alter the dose or make independent decisions about administration.
Care staff should ensure that the service user swallows the medication as prescribed and document the administration in the MAR chart.
If a dose is missed, refused, or vomited, care staff must report this to the Registered Manager and GP for guidance.

5.3 Storage and Handling of Anticoagulants

Warfarin and other anticoagulants must be stored in a secure, temperature-controlled environment.
Medication expiry dates must be checked regularly to prevent the use of outdated stock.
Staff must wear gloves and follow infection control procedures when handling medication.

6. Recognising and Responding to Side Effects and Emergencies

6.1 Signs of Excessive Anticoagulation (Bleeding Risks)

Care staff must immediately report and escalate if a service user experiences:

Unusual bruising or prolonged bleeding from cuts.
Nosebleeds lasting more than 10 minutes.
Blood in urine or stools (red or black).
Unexplained severe headaches or dizziness (possible internal bleeding).
Coughing up blood or vomiting blood.

6.2 Signs of Inadequate Anticoagulation (Clotting Risks)

Emergency medical attention is required if a service user experiences:

Sudden chest pain or difficulty breathing (possible pulmonary embolism).
Leg swelling or pain (possible deep vein thrombosis).
Sudden weakness, numbness, or speech difficulty (possible stroke).

If any of these symptoms occur, staff must contact emergency services immediately (999) and inform the GP or specialist team.

7. Dietary and Drug Interactions

7.1 Dietary Considerations

Certain foods can affect warfarin levels. Care staff should be aware that:

Vitamin K-rich foods (e.g., spinach, kale, broccoli) can reduce warfarin effectiveness.
Cranberry juice and alcohol can increase bleeding risk.
Service users should maintain a consistent diet to avoid fluctuations in INR levels.

7.2 Medication Interactions

Care staff must ensure that no additional medications, including over-the-counter drugs or herbal supplements, are given without medical approval.
Common medications that interact with warfarin include aspirin, ibuprofen, and antibiotics.

8. Training and Competency Requirements

All care staff involved in anticoagulant management must:

Complete specialist training on anticoagulant therapy risks and safe administration.
Undergo regular competency assessments to ensure compliance with best practices.
Be aware of CIW guidance on medication safety and infection control procedures.

9. Documentation and Audit Procedures

To ensure compliance and best practice, {{org_field_name}} implements:

Daily MAR chart reviews to ensure accurate medication administration records.
Quarterly audits of warfarin and anticoagulant management, led by the Registered Manager.
Incident reporting procedures for medication errors, adverse effects, or missed doses.
Clear communication with external healthcare providers, ensuring all INR results and dosage adjustments are documented and actioned correctly.

10. Related Policies

This policy should be read alongside:

Medication Management and Administration Policy (DCW21)
Infection Prevention and Control Policy (DCW17)
Safe Care and Treatment Policy (DCW11)
Staff Supervision, Training, and Development Policy (DCW27)
Managing Accidents, Incidents, and Near Misses Policy (DCW24)

11. Policy Review

This policy will be reviewed annually or sooner if legislation, CIW guidelines, or best practices change. All updates will be communicated to staff, service users, and healthcare partners.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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