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Q Bulletin, Volume 1, No. 33 (Supplement 1), Jan - Dec 202412th National QA Convention, 8 %u2013 10 October 2024OP-01Increasing the Percentage of Valve Replacement (VR) Patients Achieving OptimumTime in Therapeutic Range (TTR) on Lifelong Warfarin TherapyKwan EW1, Alyaa Madihah AT1, Fahmi Adli AR1, Nasreen N1, Norzahidah Z1, Nurzuraini Y1, Thilaga M1,Najwa CA1, Marhani I11Hospital Tengku Ampuan Afzan, Kuantan, PahangSELECTION OF OPPORTUNITIES FOR IMPROVEMENT:Time in Therapeutic Range (TTR) is used to determine the efficacy and safety of warfarin therapy.Suboptimal TTR increases bleeding and thrombosis risk. In 2020, there were four fatalities among the 25patients admitted to HTAA due to overwarfarinization. In the study conducted in 2021, it was found that only46.7% of patients achieved optimum TTR.KEY MEASURES FOR IMPROVEMENT:The indicator of this study was the percentage of valve replacement patients on lifelong warfarin therapyachieving optimum TTR, with the standard set as 65% and more.PROCESS OF GATHERING INFORMATION:A quality improvement study with a universal sampling technique was conducted from March 2022 untilDecember 2023 on 109 valve replacement patients. TTR data was extracted from the clinic database.Interview sessions with 109 patients and TTR surveys for 27 staff were conducted to determine thecontributing factors for suboptimal TTR.ANALYSIS AND INTERPRETATION:The pre-remedial study showed only 52.3% of valve replacement patients achieving optimum TTR.Contributing factors identified were multifactorial which included poor TTR knowledge (100.0%),warfarin-diet interactions (80.7%), missed dose (22.0%) and wrong dose taken (10.1%).STRATEGIES FOR CHANGE:In this study, Pocket TTR together with a pharmacy hotline was created to improve TTR knowledge amongpatients and staff. FLIPME counselling reference was used to address food-warfarin interactions. Pill-ALERTwas beneficial for staff to identify a patient's specific warfarin regime, which was then clearly written on theEZ-Labels.EFFECT OF CHANGE:The percentage of patients achieving optimum TTR in this cycle improved to 78.9%, with ABNA of -13.9%.Improved TTR knowledge (87.2%), reduced warfarin-diet interactions (56.0%), reduced missed dosefrequency (85.3%), and correct dose taken (97.2%) also showed improvements.THE NEXT STEP:We plan to involve dieticians to provide counselling regarding warfarin-diet interactions in the next studycycle and expand remedial actions to all warfarin patients.26 | Page