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A multidimensional collaborative quality improvement effort resulted in improved patient safety in the use of anticoagulation therapy in a community clinic setting. Primary Health Care Centers (PHCC) in Trenton and Rossville, Georgia, used AHRQ's DVD and brochure "Staying Active and Healthy With Blood Thinners" as part of an educational program that helps patients safely manage their anticoagulation therapy and overall health. The two facilities are Federally Qualified Health Centers, which receive federal grants to offset costs involved in providing health care to low-income and uninsured individuals.

PHCC launched an initiative in March 2009 in conjunction with Alliant/GMCF, the Georgia Quality Improvement Organization (QIO), to improve the health of some 75 patients who take warfarin. The goal was to educate patients about the need for regular laboratory tests and other important issues relating to the use of the drug. The initiative included the following interventions:

• Staff education.
• Patient resources, including AHRQ's blood thinner DVD and brochure.
• Electronic health records enhancements.
• Process redesign.
• Clinic poster that says "Attention: patients taking Coumadin—ask about your FREE warfarin kit with important information about your medication."

As a result of the effort, the number of patients coming in for regular blood tests—which are vital for monitoring patients who are on anticoagulation therapy—increased from 56 percent to almost 82 percent. PHCC also received a patient safety award from the Georgia QIO for its efforts in improving the health and care of patients using anticoagulants.

PHCC's Charline Watkins, certified professional coder and quality improvement coordinator, says, "Through a series of trials, we found the most effective way to make sure the educational materials were given to the patients. We were fortunate to have a laboratory technician who felt passionate about educating patients and handing out the patient education kits. The feedback was that patients felt truly cared for when they received their Warfarin Medication Safety Kit."

The patient safety kits included the following components:

• Bags for bringing medications to appointments.
• Red bracelet with the wording "Warfarin alert."
• Wallet card that says "I'm taking WARFARIN" on one side and a list of common drugs that interact negatively with the drug on the other.

"For some patients, the bracelet that came in the kit was too small to wear. For those patients, the laboratory technician was creative and found a way to put it on their key chains," Watkins explains. "It really seemed to spark an interest among patients to make sure they take care of themselves. It also gave them a sense of pride knowing their primary care physician's office cared enough to help increase their awareness of their own health and wellness."

In addition, she continues, "We also started taking more ownership of our patients' overall care. We learned ways to alert the medical staff and providers of patients on warfarin by flagging patient charts in our electronic medical record, and have started applying it to other health care measures as well. What's more, we are now offering a 'Patient Visit Summary' after each visit for patients to take to their other health care specialists."

Calling the collaborative effort a "win/win for everyone," Watkins notes that the patient safety award and a poster highlighting the anticoagulation education are displayed prominently. That way, she explains, "Patients can share the glory, knowing their efforts helped make the award possible."

The ´óÏóAPPblood thinner DVD helps patients better understand anticoagulation therapy and how to manage it effectively. It is designed to complement education that patients receive in their doctor's office, clinic, pharmacy, or hospital. The video can be downloaded at .