Jacee Robison1, MS, BSN, RN; Jia-Wen Guo2, PhD, RN Critical Factors For Developing A Personalized Warfarin Dosing Protocol: A Scoping Review Analysis Jacee Robison1, MS, BSN, RN; Jia-Wen Guo2, PhD, RN 13M Health Information Systems, Inc., Murray, Utah, U.S.A 2University of Utah College of Nursing, Salt Lake City, Utah, U.S.A Therapeutic ranges vary depending on the disorder that the patient has. Variance of range in those with a-fib, heart valve replacements, DVT’s, PE’s, etc. Background Results Majority of Warfarin dosing protocols were inconsistent across settings Factors included vary among protocols Four main domains were suggested for developing a personalized Warfarin dosing protocol: Genomics, Demographics, Health Behaviors, and Clinical Factors Warfarin is commonly prescribed in the U.S. Warfarin has a narrow therapeutic range which requires frequent lab work and adjustments Warfarin has serious risks (bleeding, clots) There is a need for dosing protocols that facilitate risk reduction and improve outcomes Objective Identify the critical factors that need to be considered when developing a protocol for personalized Warfarin dosing from existing literature and clinical guidelines Conclusions Methods Scoping Review Following Arksey and O’Malley’s framework Databases: PubMed, CINAHL, and Google Scholar Search terms: “Pharmacogenomic”, “Warfarin”, “Adult”, “Standard”, “Protocol”, “Personalized Medicine” and “Precision Medicine” Inclusion criteria: Full text, >2007 Results: 16,854 articles, 12,424 excluded, 252 reviewed, 32 included Content analysis 32 articles were reviewed Inter-reviewer reliability: Agreement: 0.99 Cohen’s Kappa: 0.93 More research is needed to improve safety of Warfarin dosing in patients Interdisciplinary collaboration to form a comprehensive “Gold Standard” protocol Develop Warfarin Clinical Decision Support Systems that include essential factors Comparative effectiveness research studies to address and evaluate Warfarin protocols Dosing protocols utilizing a theoretical framework to guide process design Contact Information Jacee Robison: jrobison@mmm.com Jia-Wen Guo: jia-wen.guo@nurs.utah.edu