Efficacy of protocol-based pharmacotherapy management on anticoagulation with warfarin for patients with cardiovascular surgery

Katada, Yasuyuki; Nakagawa, Shoichi; Minakata, Kenji; Odaka, Mizuho; Taue, Hiromi; Sato, Yuki; Yonezawa, Atsushi; Kayano, Yuichiro; Yano, Ikuko; Nakatsu, Taro; Sakamoto, Kazuhisa; Uehara, Kyokun; Sakaguchi, Hisashi; Yamazaki, Kazuhiro; Minatoya, Kenji; Sakata, Ryuzo; Matsubara, Kazuo

doi:10.1111/jcpt.12560

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…Several studies have reported the efficacy of the use of physician‐approved protocols by pharmacists in pharmaceutical care . Further, the introduction of standardised protocols has also been useful for preventing medication errors .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported the efficacy of the use of physician-approved protocols by pharmacists in pharmaceutical care. [11][12][13] Further, the introduction of standardised protocols has also been useful for preventing medication errors. 14,15 The present study clearly demonstrates that implementation of protocol-based management based on co-operation between physicians and pharmacists that consists of checking the criteria for administration of anticancer drugs was useful for reducing anticancer drug wastage after preparation.…”

Section: F I G U R E 3 Comparison Of the Percentage (A) And Cost (B) mentioning

confidence: 99%

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Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage

et al. 2019

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Background The increasing cost of anticancer drugs is now being recognised as a global problem, and measures against drug wastage are among the most important cost containment strategies for anticancer drugs. Objective When blood examination results or changes to a patient's condition necessitate dose reduction or discontinuation of anticancer drugs after their preparation, the compounded anticancer drugs are discarded. To reduce anticancer drug wastage after preparation, we developed a protocol that set the eligibility, start of treatment, dose reduction and discontinuation criteria for injectable anticancer drugs and assessed the effect of pharmacists' checks of these criteria based on the present protocol prior to preparation of injectable anticancer drugs. Method Observations before and after introduction of the protocol were conducted at Gifu University Hospital. We recorded the number, type and cost of anticancer drugs discarded after preparation and the reason for discarding these drugs in our dedicated database. Results Checking the criteria for anticancer drug administration before preparation significantly reduced the rate at which anticancer drugs within a chemotherapy cycle were discarded after preparation compared with that prior to the protocol's introduction (0.367% [18/4909] vs 0.032% [2/6248], P < .001). Additionally, the total cost of anticancer drugs discarded after preparation was reduced from JPY 2 041 786 (USD 18 562) to JPY 398 414 (USD 3622). Conclusion Pharmacists' checks of the eligibility, start of treatment, dose reduction and discontinuation criteria for anticancer drugs based on the present protocol prior to preparation of injectable anticancer drugs was useful for reducing drug wastage after preparation.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R E 3 Comparison Of the Percentage (A) And Cost (B) mentioning

confidence: 99%

Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage

et al. 2019

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“…Our findings demonstrated that implementation of pharmaceutical warfarin therapy management for patients with poor quality of anticoagulation was able to improve TTR values when compared to the TTR of the same patient 1 year before starting the follow-up with the pharmacist. The major differences of our study with previous that have already shown a significant improvement in coagulation therapy are: our study is composed of two phases (retrospective and prospective phases), rather than only retrospective analysis; these previous studies included general patients, whereas our study included only patients with unstable dose and poor quality of warfarin therapy (TTR < 50%); and they are randomized trials, whereas our study was performed by using paired comparisons (the subjects’ TTR were assessed and compared before and after pharmacist-driven warfarin therapy management, in a way that before receiving pharmacist-guidance the patients received warfarin traditional treatment by physicians) ( Saokaew et al, 2012 ; Verret et al, 2012 ; Katada et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin

et al. 2018

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Thromboembolic events are associated with high mortality and morbidity indexes. In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics. Some studies on the literature about oral anticoagulant management showed that pharmacists could improve the efficiency of anticoagulant therapy. However, the majority of these studies included general patients retrospectively. The aim of this study was to prospectively evaluate a pharmacist’s warfarin management in patients with poor quality of anticoagulation therapy (Time in the Therapeutic Range- TTR < 50%). We included 268 patients with atrial fibrillation (AF) and without stable dose of warfarin (TTR < 50%, based on the last three values of International Normalized Ratio-INR). We followed them up for 12 weeks, INR values were evaluated and, when necessary, the dose adjustments were performed. During the first four visits, patient’s INR was measured every 7 days. Then, if INR was within the target therapeutic range (INR: 2–3), the patient was asked to return in 30 days. However, if INR was out the therapeutic target, the patient was asked to return in 7 days. Adherence evaluation was measured through questionnaires and by counting the pills taken. Comparison between basal TTR (which was calculated based on the three last INR values before prospective phase) and TTR of 4 weeks (calculated by considering the INR tests from visits 0 to 4, in the prospective phase of the study) and basal TTR and TTR of 12 weeks (calculated based on the INR tests from visits 0 to 12, in the prospective phase of the study) revealed significant statistical differences (0.144 ± 0.010 vs. 0.382 ± 0.016; and 0.144 ± 0.010 vs. 0.543 ± 0.014, p < 0.001, respectively). We also observed that the mean TTR of 1 year before (retrospective phase) was lower than TTR value after 12 weeks of pharmacist-driven treatment (prospective phase) (0.320 ± 0.015; 0.540 ± 0.015, p < 0.001). In conclusion, pharmaceutical care was able to improve TTR values in patients with AF and poor quality of anticoagulation with warfarin.

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“…These agreements often allow the PCPh to assess, review, and modify drug therapy independently, allowing the pharmacist to practice at the highest level within licensure. Examples of potential targets for CPAs may include the management of pain, delirium, gastric acid secretion, antimicrobial prophylaxis, blood glucose, and anticoagulation based on previously reported outcomes …”

Section: Conclusion and Future Of Perioperative Clinical Pharmacymentioning

confidence: 99%

“…Examples of potential targets for CPAs may include the management of pain, delirium, gastric acid secretion, antimicrobial prophylaxis, blood glucose, and anticoagulation based on previously reported outcomes. 18,21,[56][57][58][59] Telemedicine-based clinician support systems, when applied to the…”

Section: Pharmacy Student Education In Perioperative Carementioning

confidence: 99%

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

Patel

Hyland

Birrer

et al. 2019

J Am Coll Clin Pharm

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Current published guidelines for perioperative pharmacy services have limited information on the development and implementation of a robust clinical pharmacy program across the surgical continuum of care. This publication defines the responsibilities and scope of practice of the Perioperative Clinical Pharmacist (PCPh), supporting the PCPh as a critical member of the interprofessional surgical patient care team. Opportunities for pharmacist role integration into perioperative medication management processes are described along with published examples of successful PCPh practice models, including those with interventions targeted toward Enhanced Recovery Pathways (ERP). Recommended training and competencies for future and practicing perioperative pharmacists, in addition to considerations for precepting and scholarly activities, are also outlined. Finally, future developments in perioperative pharmacy practice are discussed, including technological advancements, improved predictive models, and expansion of collaborative practice agreements.

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Efficacy of protocol-based pharmacotherapy management on anticoagulation with warfarin for patients with cardiovascular surgery

Abstract: Warfarin therapy based on our novel PBPM was clinically safe and resulted in significantly better anticoagulation control compared to conventional care.

Cited by 13 publications

References 27 publications

Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage

Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage

Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

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