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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 person-centred management of warfarin and other anticoagulant therapies within {{org_field_name}}. Given the risks associated with anticoagulants, including bleeding complications and drug interactions, this policy establishes clear procedures for the administration, monitoring, and management of warfarin therapy. Our goal is to maintain service user safety while ensuring compliance with healthcare regulations and best practices.

2. Scope

This policy applies to all employees, care workers, management, and healthcare professionals involved in supporting service users who are prescribed warfarin or other anticoagulants. It covers:

• Safe administration and monitoring of anticoagulant therapy.
• Risk assessments and individualised care planning.
• Management of missed or incorrect doses.
• Handling adverse reactions and medical emergencies.
• Staff training and competency requirements.
• Communication with healthcare providers and service users.
• Compliance with regulatory standards and record-keeping.

3. Legal and Regulatory Framework

This policy aligns with the following legislation and guidance:

• The Medicines Act 1968 – Governs the lawful administration and prescription of medications.
• The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Ensures safe and effective medication management.
• Care Quality Commission (CQC) Guidance on Managing Medicines in Care Homes and Domiciliary Care – Provides best practice standards.
• National Institute for Health and Care Excellence (NICE) NG196 Guidance on Anticoagulant Therapy – Sets out guidelines for anticoagulation safety.
• The Mental Capacity Act 2005 – Ensures informed consent and best-interest decision-making for service users who lack capacity.
• General Data Protection Regulation (GDPR) 2018 – Governs the confidentiality and secure storage of medication records.

4. Risk Assessment and Individualised Care Planning

A comprehensive risk assessment is conducted for each service user prescribed anticoagulant therapy, assessing:

• Medical history and comorbidities that may increase bleeding risk.
• Understanding of warfarin therapy and ability to self-administer.
• Possible drug interactions with existing medications.
• Dietary considerations, as certain foods affect warfarin metabolism.
• Frequency of International Normalised Ratio (INR) monitoring and healthcare provider coordination.

Based on the assessment, an individualised anticoagulant care plan is developed, detailing medication administration, INR monitoring schedules, and emergency protocols.

5. Safe Administration and Monitoring

To ensure the safe administration of warfarin and anticoagulants, care workers must:

• Verify prescriptions before each administration to confirm the correct dose, frequency, and timing.
• Document each administration in the service user’s medication administration record (MAR) chart.
• Monitor for adverse reactions, such as excessive bruising, prolonged bleeding, or signs of internal haemorrhage.
• Support service users in attending INR monitoring appointments or liaise with healthcare professionals for home INR testing.
• Report any changes in medication, missed doses, or abnormal INR readings to the prescribing healthcare professional immediately.

6. Management of Missed or Incorrect Doses

If a dose of warfarin or another anticoagulant is missed or incorrectly administered:

• Do not double the next dose.
• Report the incident immediately to a senior staff member and the service user’s GP or anticoagulation clinic.
• Document the error and any advice given by the healthcare professional.
• Monitor the service user for any signs of bleeding complications or clotting risks.

7. Handling Adverse Reactions and Medical Emergencies

Care workers must be trained to identify and respond to adverse reactions, including:

• Signs of excessive anticoagulation (bleeding complications):
  • Unexplained bruising or bleeding gums.
  • Blood in urine or stools.
  • Prolonged nosebleeds or coughing up blood.
• Signs of under-anticoagulation (clotting risks):
  • Sudden chest pain or shortness of breath (potential pulmonary embolism).
  • Swelling or pain in the legs (possible deep vein thrombosis).
  • Stroke-like symptoms (slurred speech, weakness, facial drooping).

Emergency Response Protocol:

• Call 999 or 112 for severe bleeding, suspected stroke, or respiratory distress.
• Apply direct pressure to external bleeding wounds.
• Provide reassurance and keep the service user calm.
• Contact the GP or NHS 111 for non-emergency concerns.
• Document the incident thoroughly and follow up with the prescribing clinician.

8. Communication with Healthcare Providers and Service Users

Effective communication is essential for safe anticoagulant management. Care workers must:

• Keep accurate and up-to-date medication records.
• Liaise with GPs, anticoagulation clinics, and pharmacies regarding dose changes or concerns.
• Educate service users about the importance of adherence to INR monitoring and medication schedules.
• Inform service users about dietary restrictions, avoiding excessive consumption of vitamin K-rich foods (e.g., leafy greens) that affect warfarin metabolism.
• Ensure service users understand signs of complications and when to seek medical attention.

9. Staff Training and Competency Requirements

All staff involved in anticoagulant management must receive training covering:

• The mechanism of action and risks of anticoagulants.
• Safe administration and use of INR monitoring devices.
• Recognition and management of adverse drug reactions.
• Incident reporting procedures for medication errors.
• Record-keeping and compliance with CQC medication management guidelines.
• Emergency response to anticoagulant complications.

Training is mandatory for all care workers and is refreshed annually to ensure continued competency.

10. Compliance Monitoring and Continuous Improvement

To maintain best practice standards, {{org_field_name}}:

• Conducts regular audits of medication records and administration practices.
• Reviews incident reports and near misses to identify areas for improvement.
• Holds staff refresher training sessions based on audit findings.
• Engages with healthcare professionals to align policies with current best practices.
• Seeks service user and family feedback to assess the effectiveness of anticoagulant care.

11. Policy Review and Updates

This policy is reviewed annually or sooner if significant updates in anticoagulant management guidelines occur. Any amendments are communicated to staff, and additional training is provided where necessary.

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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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.