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Q Bulletin, Volume 1, No. 32 (Supplement 1), Jan - Dec 202412th National QA Convention, 8 %u2013 10 October 2024OP-10Increasing the Percentage of Warfarin Patients with Good Time in TherapeuticRange Control in Klinik Kesihatan Sultan IsmailWang SL, Ros Azima M, Ngo SS, Wong XL, Ling JH, Siti Hajar TKlinik Kesihatan Sultan Ismail, Johor Bahru, JohorSELECTION OF OPPORTUNITIES FOR IMPROVEMENT:Time in therapeutic range (TTR) measures the percentage of time the patient%u2019s International NormalizedRatio (INR) is within the therapeutic range, reflecting the quality of anticoagulation control. Poor TTRcontrol increases patients%u2019 risk of thromboembolic events, bleeding, hospitalisations, and mortality.Pre-remedial study revealed that 58% (n=102) of patients achieved good TTR control (defined as TTR >60%).KEY MEASURES FOR IMPROVEMENT:The indicator was measured by determining the percentage of warfarin-treated patients with good TTRcontrol and the standard should be %u226565%. The standard was based on the Quality Assurance Programme(QAP) Indicators Manual 2023.PROCESS OF GATHERING INFORMATION:A quality improvement study was carried out in two consecutive phases. Patients' INR levels werecollected via Chemolims to assess TTR control. Questionnaires were disseminated to doctors,pharmacists, and patients to identify the contributing factors.ANALYSIS AND INTERPRETATION:The study identified several contributing factors, including incomplete patient history-taking byprescribers (80%, n=24), lack of counselling by pharmacists (50%, n=15), non-compliance with thewarfarin diet (60%, n=18), and dosage (20%, n=6).STRATEGIES FOR CHANGE:Warfarin checklist (Warf-check) was developed to streamline the process of taking patients' history.Express Warfarin Calculator (E-Warf) was introduced to expedite the calculation of dosage adjustments.Warfarin extended counselling (Warf-EC) was established to provide more focused counselling sessionsfor high-risk warfarin-treated patients. Educational sessions were conducted for both doctors andpharmacists to enhance their knowledge and understanding. Lastly, the K-WARF protocol was developedas a guide for managing warfarin therapy.EFFECT OF CHANGE:In cycle 1, the percentage of patients achieving good TTR control increased from 58% to 68%, andfurther improved to 69% in cycle 2. The Achievable Benefit Not Achieved decreased from 7% to -3% incycle 1 and to -4% in cycle 2. The average number of INR visits per patient decreased from 6 to 3 visitswithin a 6-month period.THE NEXT STEP:K-WARF protocol will be disseminated at the FMS Conference 2024.35 | Page