Implementing anticoagulation management by pharmacists in the inpatient setting

Dager, William E.; Gulseth, Michael P.

doi:10.2146/ajhp060133

Cited by 40 publications

(49 citation statements)

References 36 publications

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“…There are currently several excellent resources available for pharmacists who are not currently involved in anticoagulation management. [26][27][28] It is not surprising that dosing errors were less frequent in the pharmacist-managed DTI protocol group. Because the pharmacist was actually calculating the dose and entering the order, mistakes that can occur with telephone and verbal orders were minimized.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia

et al. 2010

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Use of direct-thrombin inhibitors (DTIs) for the management of patients with heparin-induced thrombocytopenia (HIT) is challenging. A pharmacist-managed DTI protocol was implemented to standardize and improve the care of patients with HIT. A background study that compared DTI protocol-treated patients to those who did not receive treatment with the DTI protocol found that significantly more of the DTI protocol-treated patients received care that was consistent with level 1 guidelines from the American College of Chest Physicians (41% vs 0%). Because outcomes were poor regardless of whether the DTI protocol was used, the protocol was revised to require pharmacist implementation and oversight. A follow-up study compared DTI protocol patients from the background study (non-pharmacist-managed) to the pharmacist-managed DTI protocol group. There were significantly fewer dosing errors, improved nursing documentation, and less reexposure to heparin when the pharmacist was responsible for managing the DTI protocol. A trend toward reduced bleeding was noted. The management of patients with HIT is complex, and there are a number of pitfalls that may lead to poor outcomes. DTIs are high-risk medications that require careful dosing and monitoring to minimize risk for adverse drug events. A DTI protocol may improve care of patients with HIT, and pharmacist oversight of DTI use can help to reduce risk for errors and adverse medication events.

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Section: Discussionmentioning

confidence: 99%

Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia

et al. 2010

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“…The AMS used existing resources to create the new anticoagulation program, rather than developing a consult service staffed with anticoagulation specialists. 2,5 The goal was to advance the medical center's pharmacy practice model such that pharmacists are more involved in providing safe anticoagulation therapy. 3,4 Development of an anticoagulation work group.…”

Section: Analysis and Resolutionmentioning

confidence: 99%

Development and implementation of a pharmacist-managed inpatient anticoagulation monitoring program

Wellman

Kraus

Burton

et al. 2011

American Journal of Health-System Pharmacy

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PURPOSE. A stepwise approach to development and implementation of a program to standardize and increase pharmacists' involvement in anticoagulation therapy at a large academic medical center is described. SUMMARY. In response to the Joint Commission's national goal of improved patient safety in anticoagulation therapy, a work group of pharmacy administrators, educators, clinical specialists, and decentralized pharmacists at the hospital developed the structure for a comprehensive inpatient anticoagulation program (IAP); the work group also developed a list of required competencies, educational materials, assessment methods, and mechanisms for eliciting feedback from IAP pharmacists and other patient care staff. After completion of training that included structured case-review sessions, a one-on-one shadowing experience, and competency assessment, IAP pharmacists began reviewing clinical and laboratory data on patients receiving warfarin and low-molecular-weight heparins and providing recommendations to physicians, nurse practitioners, and other health care team members. Feedback from other clinicians was generally positive, with a majority of those surveyed indicating that increased pharmacist involvement in anticoagulation monitoring and dosage adjustment resulted in improved patient care; about 80% indicated that they concurred with pharmacists' recommendations at least 75% of the time. Results of a survey of IAP pharmacists indicated increased satisfaction with their daily duties but also a need for improved pharmacist-to-pharmacist communication. CONCLUSION. Case-based advanced training and implementation of an IAP in a tertiary care hospital increased pharmacists' involvement in the management of inpatients receiving anticoagulants.

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“…2 While data regarding patient outcomes in an outpatient anticoagulation management service (AMS) are plentiful, relatively little has been published on the effect of a hospital-based, pharmacist-led warfarin management service on patient outcomes. [3][4][5][6] Furthermore, the assessments that have been published included relatively small numbers of patients, making comparisons to other services problematic. This article describes a large, inpatient, pharmacist-led AMS and the associated patient outcomes.…”

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confidence: 99%

Inpatient warfarin: Experience with a pharmacist-led anticoagulation management service in a tertiary care medical center

Fowler

Gulseth

Renier

et al. 2012

American Journal of Health-System Pharmacy

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Implementing anticoagulation management by pharmacists in the inpatient setting

Cited by 40 publications

References 36 publications

Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia

Pharmacist-Managed Direct Thrombin Inhibitor Protocol Improves Care of Patients with Heparin-Induced Thrombocytopenia

Development and implementation of a pharmacist-managed inpatient anticoagulation monitoring program

Inpatient warfarin: Experience with a pharmacist-led anticoagulation management service in a tertiary care medical center

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