Background: Warfarin therapy (WT) is indicated for managing oral anticoagulation therapy (OAT) in persons with atrial fibrillation, deep vein thrombosis, pulmonary embolism, or a mechanical heart valve to reduce the risk of a stroke. Global Significance: A stroke is the leading cause of disability and the third leading cause of death in the United States, with an estimated annual total cost of $57.9 billion. Given the aging of our population, it is projected that 7.5 million individuals will hav atrial fibrillation in the United States by the year 2020 based on an expected prevalence of 13.5% for individuals greater than 75 years of age. The project manager cared for 50 patients on WT during the project. Medical expertise is needed to manage OAT in a safe manner. Frequent international normalized ratio (INR) testing was required until the recommended range was achieved. The quality of life was affected for persons due to the numerous food, alcohol, and drug interaction precautions, because of OAT, and the need to return to the physician’s office for blood tests. Foreground: There were significant gaps associated with WT: a lack of patient knowledge of WT; a lack of knowledge by the healthcare provider (HCP) that self-testing was a viable option for managing WT. The evidence-based framework for this project was the precede/proceed planning model. Methods: A literature review and synthesis for self-testing was conducted to identify the best evidence and current guidelines. The purpose of this project was to change the methodology of how the the INR was tested in this rural farming community. The change involved the way blood testing was collected; participants collected their own blood sample. The following primary outcome measures were tracked prior to launching self-testing and for the month after implementation: each participant’s INR pre- and post-self-testing, therapeutic range pre- and post-self-testing, adverse drug event (ADE) rate pre- and post-self-testing, and self-reported satisfaction with self-testing. Findings/Results: The project utilized available technology, and simplified the processes involved with INR monitoring using a portable coagulometer. The data provided the participant with knowledge on the actual blood level and eased the particpants’ distress or worries related to anticoagulation. Freedom to travel was a benefit for participants. The concept of self-care was evident in the participants’ willingness to self-test. The project results agreed with the predicted outcomes. Self-testing attenuated OAT as it reduced the morbidity and mortality rate. The INR results were within therapeutic range throughout the project. The project manager was able to leverage resources to support self-testing, as cost-effectiveness and time-saved were evident with little financial impact on the medical practice. Conclusion/Recommendations: The project manager recommended self-testing of the INR to augment the plan of care. Instituting access to care with self-testing provided a tool for testing the INR in the privacy of the participants’ home, detected subtle drifts out of the recommended therapeutic range, and provided access to care.
