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

Abstract

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.

Implementing evidence‐based patient and family education on oral anticoagulation therapy: a community‐based participatory project

“…Education about OAT is best provided by nurses who often have a close and trusting relationship with patients (Mueller & Kirch , Wellman et al . ). Patient family education about OAT needs to be based on structured assessments of patients' learning needs (Cruess et al .…”

“…, Wellman et al . ). OAT education should be well structured, but consisting of manageable, comprehensible learning units that are adjusted to the patients' health literacy and needs (Cruess et al .…”

“…To provide evidence‐based care, the health professionals need to be educated and trained to deliver comprehensive care according to guidelines for patients and their families (Bergman‐Evans , Wellman et al . , Voss ).…”

“…Health professionals need to improve their knowledge base and skills to provide such education (Wellman et al . ). Future research should focus on the transferability of this final OAT patient family education to other settings, on the processes of promoting nurses' knowledge and confidence in OAT education and on patients' satisfaction and outcomes.…”

Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution

“…[8][9][10] Involving pharmacists in the discharge process provides the opportunity for patients to receive appropriate education and instruction as well as ensure that questions are clarified prior to discharge. 11 After hospital discharge, however, patients are no longer under continuous monitoring and are responsible for their own care. Although follow-up appointments are intended to check patient progress, concerns 1 Department of Pharmacy, Jackson Memorial Hospital, Miami, FL, USA may arise between appointments.…”