Many system-level interventions have been suggested to address the challenges of warfarin therapy management. At the present time, technology-based strategies such as computerized physician order entry with clinical decision support are less amenable to widespread adoption by nursing homes. Other options such as specialized anticoagulation services are logistically difficult to implement and expensive. In addition, our prior research has suggested that such services do not yet have broad acceptance for use in the nursing home setting. Given these limitations, we propose a low technology intervention for improving the safety of anticoagulation in the nursing home. The intervention focuses on maximizing the effectiveness of communication between the nursing staff and physicians of nursing home residents on warfarin. The intervention will build on an established approach for situation briefing drawn from the U.S. armed forces: SBAR - an acronym standing for Situation, Background, Assessment, Recommendation. We will test the effectiveness of this approach and its level of adoption and acceptance through a randomized trial, and will produce and disseminate a toolkit that can be applied in other nursing homes, as well as assisted living and home health settings. If successful, this approach will serve as a model for improving the safety of other medication categories associated with high rates of preventable adverse drug events, and for protecting nursing home residents at special risk for medication-related problems.