Abstract
Background and Aims
Many orthopaedic patients admitted to hospital who require urgent surgery are also on Warfarin. Patients with an INR>2 have an increased risk of bleeding complications during surgery; however delay to surgery due to a high INR has both clinical and financial implications. This audit evaluates whether the appropriate management for correction of INR is employed as per local guidelines and, if not, whether this results in significant delay to operative treatment.
Methods
A retrospective and prospective audit was performed analysing all Orthopaedic trauma admissions admitted to University Hospital Aintree in a 5 month period. Only those solely on warfarin, who were not acutely bleeding and required surgery in <24 hours were included.
Results
A sample of 17 patients was obtained of which only 35.3% had correct INR reversal as per local guidelines. Errors that occurred included 81.1% not being given further Vitamin K at reassessment, 18.2% given too much Vitamin K, 9.1% given too little Vitamin K, 18.2% given Octaplex incorrectly and 9.1% not given Octaplex when indicated. Only 1 patient had a delay to their surgery directly resulting from incorrect INR reversal (total time to surgery − 33 hours 45 minutes).
Conclusion
Better education for clinical staff on the local policy for INR reversal in patients requiring urgent orthopaedic surgery is needed. Local policy guidelines have since been redesigned in light of these results and a completion audit cycle has been performed showing significant improvement with 50% of the patient sample given correct INR reversal.
