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Registration Number: {{org_field_registration_no}}

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Safe Management of Warfarin and Anticoagulant Therapy Policy

1. Purpose

The purpose of this policy is to ensure the safe, effective, and consistent management of Warfarin and other anticoagulant therapies for the people we support at {{org_field_name}}. Anticoagulants are high-risk medicines due to their potential for causing serious harm if not managed properly. This policy outlines clear procedures for administration, monitoring, record-keeping, and communication with healthcare professionals. It supports Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by promoting safe care and treatment through proper medicine management, risk reduction, and prevention of avoidable harm.

2. Scope

This policy applies to all staff involved in the care, support, or administration of medication to people receiving Warfarin or other anticoagulants such as Apixaban, Rivaroxaban, Edoxaban, and Dabigatran. It covers registered nurses, care staff, medication technicians, the Registered Manager, and any staff responsible for coordinating or supervising care. It also applies to bank and agency staff when working under the direction of {{org_field_name}}. The policy includes guidance on new admissions, ongoing monitoring, inter-professional communication, and escalation of concerns relating to anticoagulant therapy.

3. Related Policies

• CH11 – Safe Care and Treatment Policy
• CH21 – Medication Management and Administration Policy
• CH17 – Infection Prevention and Control Policy
• CH18 – Risk Management and Assessment Policy
• CH27 – Staff Supervision, Training, and Development Policy
• CH35 – Duty of Candour Policy

4. Medication Risk Classification

Anticoagulants are classified as high-risk medications due to the narrow therapeutic window and increased risk of bleeding complications. Warfarin in particular requires careful monitoring of INR (International Normalised Ratio) levels. Staff must recognise the signs of bleeding or clotting and act immediately. These risks make robust systems of training, communication, and monitoring essential. All anticoagulant therapy must be supported by a documented risk assessment and care plan for each individual.

5. Admission and Assessment Procedures

At the point of admission or commencement of support, a thorough medication risk assessment is undertaken for any person prescribed Warfarin or other anticoagulants. This includes obtaining recent INR results, the person’s Anticoagulation Clinic contact details, and a copy of their Yellow Book or dosage sheet. The assessment is reviewed by the Registered Manager or delegated lead and documented in the individual’s care plan. Staff must confirm whether administration is required or if the person self-manages with or without family support. Consent must be clearly documented, and where capacity is in question, a Mental Capacity Assessment must be completed and the best interest decision made in accordance with the Mental Capacity Act 2005.

6. Care Planning and Documentation

A detailed anticoagulant care plan must be in place and reviewed after every INR test. This care plan must include the prescribed dose, administration times, frequency of INR testing, target INR range, known side effects or adverse reactions, and emergency procedures. All dosage changes must be documented immediately and signed by the authorised prescriber. Staff must ensure that the correct version of the Warfarin chart is always used and that out-of-date versions are removed to avoid errors. A copy of all INR results must be kept in the medication records. Any non-prescribed substances (e.g., over-the-counter medications, herbal supplements) that may interact with anticoagulants must be recorded and reviewed for safety.

7. Monitoring and INR Management

INR results must be obtained on the same day as testing and recorded clearly in the person’s Medication Administration Record (MAR) chart and care plan. Where INR testing is done by external services (e.g., GP or clinic), the updated dosage must be verified by two staff members before administration. If test results are delayed or unavailable, Warfarin must not be administered until clear instruction is obtained from a prescriber. Any deviation from the prescribed dose or schedule must be treated as a medication error and reported immediately. If an individual shows signs of excessive bruising, bleeding, confusion, or clotting, emergency services must be contacted and the incident recorded in line with our Incident Reporting Policy.

8. Safe Administration Practices

Only trained and authorised staff may administer Warfarin or anticoagulants. Double-checking procedures must be followed for every dose, including verification of the person’s identity, dosage against the most recent INR result, and time of administration. Staff must never guess or estimate a Warfarin dose. A second staff member must verify the dosage and document confirmation. Staff must avoid administering Warfarin with foods known to interfere with absorption (e.g., high-vitamin K foods like spinach, kale). Warfarin must not be crushed unless explicitly stated by the prescriber. Appropriate gloves and hand hygiene must be followed in accordance with CH17 – Infection Prevention and Control Policy.

9. Communication with Health Professionals

{{org_field_name}} staff must maintain close and proactive communication with GPs, community nurses, and anticoagulation clinics. All changes in condition, INR levels outside of range, signs of adverse reactions, or concerns must be reported promptly to the prescriber. Staff must advocate for timely INR testing and ensure that the results are received and documented on the same day. If the service user is discharged from hospital with new anticoagulant prescriptions, these must be verified with the discharging team and GP before administration resumes. Any communication must be documented in the person’s care notes and shared appropriately during shift handovers.

10. Staff Training and Competency

All staff responsible for anticoagulant administration must complete accredited medication training and competency assessments annually. Additional specific training on anticoagulant therapy, Warfarin management, and identifying complications must be provided and documented. New staff are shadowed by experienced and competent colleagues until assessed as safe to administer independently. Ongoing supervision and spot checks are carried out by the Registered Manager or Deputy Manager to ensure consistent practice.

11. Record-Keeping and Audit

Accurate records of Warfarin doses administered, INR results, communication with professionals, missed doses, and adverse events must be maintained at all times. Records must be legible, signed, and dated. Weekly audits of MAR charts and anticoagulant care plans are conducted by senior staff to check compliance and detect discrepancies. Any errors are investigated in accordance with CH24 – Management of Accidents, Incidents, and Near Misses Policy. Outcomes are discussed during staff meetings and used for learning and improvement.

12. Responding to Adverse Events

Any suspected Warfarin overdose, underdose, or adverse event must be treated as a medical emergency. Staff must:

• Call 999 if there are signs of internal bleeding, stroke, or clotting
• Inform the GP and family/representatives
• Complete an incident report
• Notify the CQC if required under Regulation 18 – Notification of Other Incidents
• Apply Duty of Candour as per CH35 – Duty of Candour Policy

A full investigation will follow and a risk review will be conducted.

13. Efficient Management by {{org_field_name}}

{{org_field_name}} ensures safe management of Warfarin through:

• Dedicated medication leads trained in anticoagulant therapy
• Digital systems to track INR dates and flag overdue tests
• Pre-visit planning for anticoagulant reviews
• Strong relationships with local GPs and pharmacies
• Use of secure communication channels (e.g., NHS mail) for prompt updates
• Thorough staff handovers and 24/7 managerial oversight

This ensures that no dose is missed, and any risks are identified early and acted upon promptly.

14. Policy Review

This policy will be reviewed annually or sooner if required by changes in legislation, best practice guidance, or following a related incident.

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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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