Date of Doctor of Nursing Practice Project Completion
Spring 4-29-2026
Faculty Advisor
Dr. Susan Stafford
Abstract
Purpose
This quality improvement (QI) project aimed to reduce uncaptured INR results by 5% over 12 weeks in an outpatient cardiovascular clinic by implementing a standardized tracking workflow.
Background
Suboptimal anticoagulation management in outpatient settings can lead to uncaptured International Normalized Ratio (INR) results, delayed therapy adjustments, and increased risk of bleeding or thromboembolic events.
Methodology
Guided by the Plan-Do-Study-Act (PDSA) framework, a pre–post intervention design was used. Interventions included an electronic medical record (EMR)-based tracking system using a reminders inbox for overdue results and nurse-led follow-up phone calls. Data was collected from the EMR and analyzed using descriptive statistics, percentages, and run charts to evaluate trends in INR capture, timeliness, and therapeutic range. The sample included adult patients receiving warfarin therapy; limitations included single-site design, manual data extraction, and variability in patient adherence and staffing.
Results
Post-intervention captured INR results increased from 62.5% to 64.8% (+2.3%), and on-time INR completion improved from 75.4% to 77.6% (+2.28%). Therapeutic INR values increased from 57.7% to 64.1% (+6.4%). Although the primary aim was not met, improvements in all measured outcomes were observed. Increased follow-up calls were associated with reduced overdue testing and improved adherence.
Implications
Implementation of an EMR-based tracking system with structured follow-up demonstrated modest but meaningful improvements in anticoagulation management. Findings support the role of standardized workflows and patient engagement in improving safety and adherence. Future efforts should focus on workflow sustainability and scalability to enhance outcomes further.
Key words: anticoagulation, INR monitoring, quality improvement, EMR, patient adherence, PDSA
Keywords
anticoagulation, INR monitoring, quality improvement, EMR, patient adherence, PDSA, outpatient cardiology, warfarin, coumadin, coumadin clinc
Recommended Citation
Antonette Atori, "Improving INR Monitoring in Outpatient Cardiology: A Quality Improvement Initiative to Enhance Anticoagulation Safety" (2026). Doctor of Nursing Practice Final Project Abstract. 179.
https://digitalcommons.library.tmc.edu/dnp_abstract/179