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DC145-Safe Management of Warfarin and Anticoagulant Therapy Policy

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Registration Number: {{org_field_registration_no}}

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. This policy applies to medicines support delivered in people’s own homes and is intended to ensure that anticoagulants, as high-risk medicines, are managed in a safe, person-centred, lawful and well-governed manner.

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:

3. Definitions and Levels of Medicines Support

For the purposes of this policy:

{{org_field_name}} will only provide medicines support where:

  1. the service user’s medicines support needs have been assessed;
  2. the type and level of support have been agreed;
  3. the support is clearly documented in the care plan and medicines records;
  4. the task falls within the worker’s role; and
  5. the worker has been trained, assessed as competent and authorised to provide that support.

Care workers must not undertake any medicines-related task outside the service user’s care plan, outside this policy, or outside their proven competence. Where there is any uncertainty, staff must stop and seek advice from the line manager, prescriber, supplying pharmacist, anticoagulation clinic or another appropriate healthcare professional.

4. Legal and Regulatory Framework

This policy is informed by and must be read alongside the following legislation, regulations and guidance applicable in England:

{{org_field_name}} will keep this policy under review to ensure it reflects current legislation, national guidance and local commissioning arrangements.

5. Risk Assessment and Individualised Care Planning

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

Each assessment and care plan for anticoagulant therapy must clearly record, as applicable:

The medicines support care plan must be developed with the service user wherever possible and, where appropriate, with relatives, advocates, attorneys, deputies and relevant healthcare professionals. It must be reviewed regularly and immediately after any anticoagulant dose change, change in health status, admission or discharge, medicines-related incident, abnormal monitoring result, refusal pattern, or any concern about safety or effectiveness.

6. Safe Administration and Monitoring

Anticoagulants are high-risk medicines. {{org_field_name}} will ensure that all anticoagulants are managed safely, administered only as prescribed, and supported in a way that reflects the service user’s assessed needs, preferences and legal rights.

Before providing any anticoagulant medicines support, staff must:

  1. confirm that the support is authorised in the care plan;
  2. check the identity of the service user;
  3. check the correct medicine, strength, dose, route, formulation and time;
  4. confirm the current instructions from the prescriber, including any recent dose change;
  5. check the MAR and any supplementary anticoagulant record, dosage schedule or clinic instruction;
  6. ask the service user about any recent bleeding, bruising, falls, illness, vomiting, new medicines or changes in diet or alcohol intake that may affect treatment; and
  7. obtain valid consent before support is given, or act in accordance with the Mental Capacity Act 2005 where the person lacks capacity.

For warfarin, staff must make sure the current dose is clearly recorded from an authorised source before administration. Where the dose varies, staff must not guess or rely on outdated information. Any uncertainty must be escalated before administration.

For DOACs, staff must pay particular attention to correct timing and frequency because omitted or delayed doses can quickly reduce anticoagulant effect.

For injectable anticoagulants, staff must only support administration where the task has been assessed, staff are trained and competent, and any required delegation arrangements are clearly documented.

All medicines support must be recorded immediately or as soon as reasonably practicable after the event, including:

Staff must monitor for side effects, lack of effect, deterioration and changes that may affect safe anticoagulant use, and must escalate concerns promptly in line with this policy and the service user’s care plan.

5.1 Time-critical administration and visit planning

Where an anticoagulant has been assessed as time-sensitive, {{org_field_name}} will plan visits and staff deployment to minimise the risk of late or missed doses. Rotas, call schedules and contingency arrangements must reflect the importance of prescribed administration times.

If staff anticipate that a visit may be late or missed, they must notify the office immediately so that alternative arrangements can be considered. The service user or their representative must be informed where appropriate, and advice must be sought promptly if the delay could affect safe anticoagulant treatment.

7. Management of Missed, Delayed, Refused, Vomited or Incorrect Doses

If an anticoagulant dose is missed, delayed, refused, vomited, given incorrectly, or there is uncertainty about whether it has been taken, staff must:

  1. ensure the service user is safe;
  2. check the care plan, MAR and any anticoagulant-specific instructions;
  3. not administer an additional or replacement dose unless this has been specifically authorised by the prescriber or anticoagulation service;
  4. immediately inform the line manager or on-call manager;
  5. seek urgent advice from the prescriber, anticoagulation clinic, supplying pharmacist, NHS 111 or emergency services as appropriate to the level of risk;
  6. record exactly what happened, including time, dose involved, who was informed and what advice was given; and
  7. monitor the person for any signs of bleeding, thrombosis or deterioration and escalate without delay if concerns arise.

Staff must never:

Any missed, delayed, refused, incorrect or uncertain anticoagulant dose must be treated as a medicines-related incident or near miss, reviewed for learning, and considered for further reporting in line with the incident reporting, safeguarding, duty of candour and CQC notification procedures.

8. Abnormal INR Results and Clinical Escalation

Where a service user is prescribed warfarin, staff must ensure that the latest INR information and current dosing instructions are available from an authorised source before supporting administration where dose changes are in place.

If staff become aware of an abnormal INR result, missed INR appointment, inability to obtain current dosing instructions, or any information suggesting over-anticoagulation or under-anticoagulation, they must:

Where the person has a significantly raised INR, bleeding, head injury, sudden collapse, stroke-like symptoms, chest pain, or signs of internal bleeding, staff must treat this as an emergency and call 999 without delay.

9. Handling Adverse Reactions and Medical Emergencies

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

Emergency Response Protocol:

Staff must also treat the following as urgent concerns requiring immediate escalation and, where appropriate, emergency services:

When requesting urgent or emergency help, staff must state clearly that the person is taking an anticoagulant and, where known, name the medicine and last dose time.

10. Communication with Healthcare Providers, Pharmacies and Service Users

Safe anticoagulant management depends on timely, accurate and documented communication between {{org_field_name}}, the service user, relevant relatives or representatives, the GP, prescriber, anticoagulation clinic, supplying pharmacy and any other involved healthcare professionals.

{{org_field_name}} will ensure that:

Service users should be encouraged, where appropriate, to keep and carry any anticoagulant alert card, monitoring booklet, clinic record or other patient-held anticoagulant information.

11. Consent, Mental Capacity and Best-Interests Decisions

Anticoagulant medicines support must only be provided with the valid consent of the service user or other relevant lawful authority.

Staff must:

Where a service user lacks capacity in relation to anticoagulant decisions, staff must ensure that any decision is made in the person’s best interests, is properly recorded, and involves relevant family members, attorneys, deputies, advocates and healthcare professionals as appropriate.

No covert administration of anticoagulants may take place unless there is a lawful best-interests decision, appropriate clinical authorisation, a documented care plan, and clear instructions for staff.

12. Staff Training, Competency and Authorisation

Only staff who have completed relevant training, had their competence assessed, and been authorised by {{org_field_name}} may provide anticoagulant medicines support.

Training and competency arrangements must include, as relevant:

{{org_field_name}} will maintain a formal process for:

Staff must not undertake any anticoagulant-related task outside the limits of their training, competency assessment and authorisation.

13. Compliance Monitoring and Continuous Improvement

To maintain best practice standards, {{org_field_name}} will operate effective governance systems for anticoagulant management, including:

Audit findings must be reviewed by management and used to improve policy, practice, staffing, training and care planning.

14. Incident Reporting, Duty of Candour and Notifications

All anticoagulant-related incidents, near misses and concerns must be reported in accordance with {{org_field_name}}’s incident reporting procedure.

This includes, but is not limited to:

Each incident must be:

Where an anticoagulant-related incident amounts to a notifiable safety incident, {{org_field_name}} will act in an open and transparent way in line with the statutory duty of candour, including giving an apology, providing truthful information, keeping records and supporting the service user and/or relevant person.

Where required by law or regulation, {{org_field_name}} will notify the Care Quality Commission and any other relevant body, such as the local authority safeguarding team, commissioner or coroner, in accordance with statutory requirements and internal procedures.

15. Policy Review and Updates

This policy will be reviewed at least annually and sooner where required by:

All amendments will be communicated to staff and, where necessary, followed by updated training, supervision and competency reassessment.

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.

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