Browsing by Author "Williams, H. S. A."

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    An audit of patients' compliance with the standards for warfarin therapy
    (Sri Lanka Medical Association, 2018) Fernando, C. H. K. A.; Costa, Y. J.; Williams, H. S. A.; Moratuwagama, D.
    INTRODUCTION AND OBJECTIVES: Warfarin is an oral anticoagulant with complex pharmacokinetics and pharmacodynamics. Therefore close monitoring is essential. Strict adherence to therapy depends on the patient's knowledge regarding anticoagulation. The objective was to assess patients' essential knowledge on warfarin with regard to anticoagulation therapy. METHODS: An audit was conducted over 6 months at Colombo North Teaching Hospital. 50 consecutive patients, of both genders, who had been on warfarin for at least 1 month were recruited. Their knowledge of warfarin therapy was evaluated using a 10 item questionnaire. Results were analyzed and compared against standards. RESULTS: Male:female ratio was 4:6 and mean age was 59.7 years. 46 % of patients had completed education up to Ordinary Level, 6% had never attended school. Indications for warfarin included: VTE 46 %, atrial fibrillation 28%, chronic cardiac dysfunction 22%, prosthetic heart valves 2%, and pulmonary hypertension 2%. 62% knew their current dose of warfarin, 4% were aware of their therapeutic INR, 68% knew what remedial action should be taken in the event of a haemorrhage, 48% were aware of effects of over anticoagulation, 22% were aware of effects of subtherapeutic anticoagulation, 86% were aware of interference of green leaves with therapy, 40% were aware ofNSAID affect anticoagulation, 70% were aware of alcohol effect on anticoagulation. CONCLUSION: As results did not meet standards, we suggest there should be better patient education regarding warfarin therapy. Patient information leaflets as well as information of this audit be made aware to teams concerned for better care of patients.
  • No Thumbnail Available
    Item
    Rational use of FFP at North Colombo Teaching Hospital: An audit
    (Sri Lanka Medical Association, 2018) Sutharsiny, Y.; Darshani, W. M. N.; Moratuwagama, H. M. D.; Costa, Y.; Williams, H. S. A.; Kularatne, W. M. M .T.
    INTRODUCTION & OBJECTIVES: The British Committee for Standards in Haematology (BCSH) provides guidelines for use of fresh frozen plasma (FFP). Inappropriate use and non-compliance with guidelines for FFP have been reported.This audit is to reinforce guidelines and avoid inappropriate use. The objectives are to check - l.The indications ofFFP use 2.Calculation of dose according to weight of patient 3.Checking of coagulation (PT/APTT) before and after FFP METHODS: Data was collected from blood bank requests for 4 months. Details were collected from a questionnaire from patients and BHTs following transfusion.RESULTS: Of 50 patients, 11 were neonates and 4 children. Indications were liver disease with abnormal coagulation (40%), DIC and severe sepsis (20%), liver disease with normal coagulation awaiting surgery (10%), and massive bleeding (8%). 14% of neonates required FFP for resuscitation and to treat sepsis.Though weight was measured in 41(82%), adequate dose was administered to 14 (28%), overestimated in 26%, and underestimated in 28%. Pre and post transfusion coagulation was done in 33 (66%) and 17 (34%) respectively. Seven (14%) had coagulation tests within 3 hours. None of the patients had informed consent, risks and benefits informed prior to transfusion. CONCLUSION: All FFP is used according to guidelines. Documentation of volume of FFP used requires improvement as ambiguity of ml or units. Each unit of FFP varies· from 180ml - 230ml. Requirement of post transfusion coagualation within 3 hours is to be emphasized. Requirement of informed consent prior to transfusion of blood products is stressed.