Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

Miele, Christina; Taylor, Mary; Shah, Aditi

doi:10.1310/hpj5203-207

Cited by 21 publications

(15 citation statements)

References 17 publications

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“…18,19 Furthermore, inpatient DOAC stewardship and monitoring programs have been described and found to improve appropriateness of DOAC prescribing. 20,21 In one study by Miele and colleagues, implementation of a pharmacist-driven DOAC protocol at a community hospital significantly reduced the total number of inappropriately administered DOAC doses by 57%. Our study builds upon their findings and includes a larger study population within an academic Although the focus of our findings is on the impact of a pharmacist-driven DOAC protocol, the role and importance of pharmacist education cannot be overemphasized.…”

Section: Discussionmentioning

confidence: 99%

Impact of a pharmacist‐to‐dose direct oral anticoagulant protocol on medication errors at an academic medical center

Willeford

Leiman

Noel

2021

J Am Coll Clin Pharm

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Background: Direct oral anticoagulants (DOACs) are considered high-risk medications and pose a serious threat to patients if mismanaged. Furthermore, medication error rates involving DOACs in the acute care setting range from 25% to 40%. To reduce medication error rates at our institution, we implemented a pharmacist-driven DOAC protocol that permitted pharmacists to independently order and monitor DOACs pursuant to a consult order.Objective: To determine the impact of a pharmacist-to-dose DOAC protocol on medication errors at an academic medical center.Methods: This was a retrospective, single-center cohort study using a pre-post design to evaluate the impact of a pharmacist-to-dose DOAC protocol on rates of medication errors. Patient data were evaluated during a 6-month period before and after the implementation of the protocol. Patients were excluded if they were receiving a DOAC for an indication other than venous thromboembolism and/or atrial fibrillation.Results: A total of 502 patients (pre-phase = 256; post-phase = 246) admitted to the hospital and receiving a DOAC were included in the study. A total of 41 patients in the pre-phase received a medication error involving a DOAC compared with 22 patients in the post-phase (16% vs 8.9%; relative risk reduction 44%; P = .017).Rates of near misses were numerically higher in the post-phase group (7.4% vs 11.8%; P = .1), and rates of discharge DOAC errors were numerically lower (8.5% vs 4.9%; P = .1). The most common error was underdosing (N = 31). Conclusion:In this study, the implementation of a pharmacist-to-dose DOAC protocol was associated with a 44% reduction in DOAC-related medication errors. These findings underscore the impact of a protocolized approach to DOAC management, as well as the role of pharmacists in overseeing inpatient DOAC use and reducing medication errors.

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Section: Discussionmentioning

confidence: 99%

Impact of a pharmacist‐to‐dose direct oral anticoagulant protocol on medication errors at an academic medical center

Willeford

Leiman

Noel

2021

J Am Coll Clin Pharm

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“…Literature assessing pharmacist-driven interventions and protocols have shown similar improvements in the practice of evidence-based medicine. 14-18 To the best of our knowledge, this study is the first to examine pharmacist-driven interventions to improve guideline-concordant therapy surrounding the new ADA recommendations for patients with type 2 diabetes and concomitant ASCVD.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacist-driven interventions have demonstrated improvement in prescribing patterns, medication adherence, chart documentation, patient education, adverse events, and quality of life. 14-18 However, the impact of a pharmacist-driven protocol to improve prescribing of diabetes medications with cardiovascular benefit in patients with type 2 diabetes and ASCVD is unknown. The purpose of this study was to determine if the implementation of a pharmacist-driven protocol was associated with an increased proportion of patients prescribed evidence-based cardiovascular risk reduction therapy with a GLP-1 receptor agonist or SGLT-2 inhibitor.…”

Section: Introductionmentioning

confidence: 99%

Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study

Freudenberg

Covington

Young

et al. 2020

Journal of Pharmacy Practice

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Purpose: To determine whether a pharmacist-driven protocol improves guideline-concordant prescribing of diabetes medications in patients with atherosclerotic cardiovascular disease (ASCVD). Methods: A retrospective pre- and post-intervention study was conducted at a university-based family medicine clinic. A pharmacist-driven protocol was implemented which involved the creation of an algorithm recommending specific diabetes medications in patients with ASCVD. An in-service presentation reviewing the algorithm and process for referral of eligible patients to an appointment with a clinical pharmacist was delivered to providers. Clinical pharmacist appointments focus was on improving diabetes management and initiating cardiovascular risk-reducing medications if appropriate. Results: A total of 234 patients were screened, and 108 met inclusion criteria. Upon completion of patient outreach, 34% were scheduled with a pharmacist. Forty-three percent of patients (16 of 37) attended the appointment. Of those, 31% were initiated on an evidence-based regimen indicated for diabetes and ASCVD. In comparing pre- to post-implementation of the pharmacist-driven protocol, the rate of guideline-concordant prescribing increased by 48% (3.8% to 5.6%). Conclusion: Implementation of a pharmacist-driven protocol can increase guideline-concordant prescribing. However, further exploration of patient- and system-level barriers is necessary to implement such a program more broadly.

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“…17 Studies have demonstrated that the implementation of a pharmacist-driven DOAC service resulted in decreased inappropriate DOAC prescribing. 18…”

Section: Discussionmentioning

confidence: 99%

The Impact of Implementing an Advance Practice Pharmacist-Led Anticoagulation Clinic Within a Correctional Facility

Tran

Lin²,

Nguyen³

et al. 2019

Journal of Pharmacy Practice

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Maintaining warfarin in the therapeutic range is clinically challenging and can be made more complex in the correctional health setting. The care of an inmate population is complicated by its episodic and often brief nature in addition to the frequent lack of consistent care prior to incarceration. As part of a process improvement effort, a descriptive study was conducted on a unique pharmacist-led anticoagulation clinic that was initiated in the Los Angeles County jail. The advanced practice pharmacist (APP) used a Collaborative Practice Agreement and had access to a physician supervisor when necessary. The patients who arrived to the jail on warfarin had their doses adjusted by the APP according to their respective international normalized ratio (INR). The primary endpoints were percentage of INR readings within therapeutic range (RR) and time in therapeutic range (TTR). Secondary endpoints included bleeding and thrombotic events. A total of 141 patients were followed by the anticoagulation clinic over the initial 8-month period from September 2017 to April 2018. Indications for warfarin included deep vein thrombosis or pulmonary embolus (67%), mechanical valve (17%), atrial fibrillation (8%), and other (8%). The average RR was 74.1% in the 8 months following APP management, which met the definition of good control (>65%). The TTR was 67% which met the definition of good control (>65%). No bleeding or thrombotic events that required hospitalization occurred. Implementation of an APP-led anticoagulation clinic in a correctional health setting resulted in good INR control as defined in community standards.

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Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

Cited by 21 publications

References 17 publications

Impact of a pharmacist‐to‐dose direct oral anticoagulant protocol on medication errors at an academic medical center

Impact of a pharmacist‐to‐dose direct oral anticoagulant protocol on medication errors at an academic medical center

Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study

The Impact of Implementing an Advance Practice Pharmacist-Led Anticoagulation Clinic Within a Correctional Facility

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