Warfarin management
The Clinical Haematology department manages warfarin therapy for over 150 children around Victoria, Tasmania and some parts of New South Wales and South Australia. These children require warfarin therapy to prevent or treat blood clots (thromboses). The majority of these children will require lifelong anticoagulation. The RCH Clinical Haematology department is the largest provider of dedicated anticoagulant management to children in Australia and has demonstrated excellent outcomes with respect to keeping children taking warfarin safe and well.
Anticoagulation Clinic Outcomes 2004
In caring for so many children, the Clinical Haematology department has established robust education processes and services to improve the quality of warfarin management for children. All children taking warfarin need to have regular blood tests to make sure the warfarin levels in the blood are right where they need to be. The blood tests used to monitor warfarin is called the International Normalised Ratio, or INR. In 2000, the Clinical Haematology department introduced point-of-care (fingerprick) INR monitoring as its standard way of monitoring warfarin therapy in children. This way of monitoring warfarin has been studied carefully and shown to be safe and reliable.
Coaguchek S validation 2004
CoaguChek XS Validation 2009
Home INR Monitoring Program
In 2003, the Clinical Haematology department extended its service through the establishment of a Home INR Monitoring program, where parents/older patients were taught to perform their own INR tests using the INR monitors in their homes.
The Home INR Program has capacity to manage up to 100 children on warfarin. This is based on our current supply of CoaguChek XSTM Monitors.
Entry into the Home INR Monitoring program is restricted to families and children who:
- Reside in Victoria
- Require warfarin for more than 12 months.
- Have English Language proficiency
- Have been on warfarin therapy for more than three months
Due to the time required for training families, it is not feasible or cost-effective to train families and supply all the consumables for home monitoring if the child only requires warfarin for a short period.
As the training program is conducted in group format, engaging interpreters to support families with limited English is not feasible.
The warfarin knowledge requirements for families of children commencing on the Home INR program is quite extensive. The education provided to families during the training supplements previous education they a have received through the Haematology Department. To ensure that families have an established understanding of warfarin therapy a child must have been on warfarin for more than three months before they are eligible to commence home monitoring. By this time, the child's warfarin therapy should be stable and the family has become more confident with day-to-day management of warfarin. Families may not commence home INR monitoring as soon as their child has been on warfarin for 3 months. Capacity within the program must allow new participants to start.
The Clinical Haematology Department conducts training for Home INR monitoring within a group format. This training approach was evaluated and found to produce excellent outcomes with respect to increasing the families' knowledge of warfarin therapy as well as their ability to perform INR tests. All training sessions take approximately seven hours. The training sessions are conducted on site at the RCH.
The Home INR monitoring program at RCH has been well studied. The Clinical Haematology department has demonstrated home INR monitoring is a safe and effective way of monitoring warfarin therapy in children and improves the quality of life for the child and their family.
Point Of Care position paper 2013
Home INR program_education 2006