Processes and Barriers to Implementation of Point-of-Care Genotype-Guided Dosing of Warfarin into UK Outpatient Anticoagulation Clinics

Figures & data

Figure 1. A schematic illustrating a typical pathway for anticoagulation with warfarin in the National Health Service.

When a decision is made to anticoagulate, patients are given a loading dose of warfarin, with subsequent INR testing utilized to modify doses according to the different types of dosing software available in different anticoagulant clinics. Genotype guided dosing involves the use of two algorithms, one at initiation (which takes into account clinical and genetic factors) and another on day 4 (which takes into account not only the clinical and genetic factors but also the INR). After day 5, the dosing follows the standard procedures utilized by the clinics.

GGD: Genotype-guided dosing; INR: International Normalized Ratio; POC: Point-of-care.

Figure 2. Operational process used in implementation of genotype-guided dosing of warfarin.

These are used as an example of the processes we used in our implementation project in the UK NHS anticoagulation clinics. These processes would need to be modified for other healthcare systems.

NHS: National Health Service; PAT: Portable appliance testing; PPI: Patient and public involvement; SOP: Standard operating procedure.

Figure 3. Some of the barriers which can exist in implementing an innovation into any healthcare system.

Adapted from [42].

Grol R , GrimshawJ. From best evidence to best practice: effective implementation of change in patients’ care. Lancet362(9391), 1225–1230 (2003).

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