Nursing - Theses
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ItemWarfarin therapy in infants and children( 2004)Much of the evidence that guides anticoagulant management in infants and children has been presumptively extrapolated from adult medicine. We now know that there are several reasons as to why such extrapolation may not be ideal. This study sought to explore key outcomes of warfarin management in infants and children. The medical literature supports a direct association between patient knowledge and the stability of warfarin therapy. Phases One and Two of this project respectively investigated Parental and Nursing staff understanding of warfarin therapy in the paediatric population. Phase Three constituted a retrospective audit of warfarin management at a single tertiary paediatric centre over a two-year period. Data collected aimed to shed light upon the efficacy and safety outcomes of warfarin therapy in this cohort. Phase Four consisted of the development and implementation of a novel parent education program, which was piloted in a trial of home monitoring of warfarin therapy. Results of Phases One and Two demonstrated that parental and nursing understanding of warfarin therapy in children is poor. Although a causative link cannot be proven between the level of knowledge each of these cohorts possess, the role nurses play as educators must be reviewed in light of these outcomes. Phase Four demonstrated that parental understanding of warfarin therapy significantly improved following implementation of a novel education program, and these improved knowledge outcomes can be sustained over time. This program facilitated the implementation and evaluation of a home INR monitoring pilot study. Target therapeutic range (INR) achievement compared favourably with studies reported in adult patients, despite the presence of numerous confounding factors in the paediatric population. However, adverse event rates were higher than has previously been reported for similar paediatric populations. The incidence of adverse events appeared to be greater in patients not managed by a dedicated anticoagulant clinic. Warfarin management in children presents unique challenges that must be addressed if optimal anticoagulant therapy is to be achieved.