Establishing an inpatient anticoagulation service: a step by step review

Viercinski, John; Thomson, Lynda; Wilson, J.V.; Merli, Geno J.

doi:10.1007/s11239-007-0111-z

Cited by 2 publications

(2 citation statements)

References 9 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%

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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%

“…There are currently several excellent resources available for pharmacists who are not currently involved in anticoagulation management. 26–28…”

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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Challenges and benefits of an inpatient anticoagulation service: one hospital’s experience

Burnett

D’Angio

Earl

et al. 2011

J Thromb Thrombolysis

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While outpatient anticoagulation services (AMS) have existed extensively for a number of years, inpatient AMS have only recently begun to be implemented on a widespread basis. This is in direct response to anticoagulation regulations set forth by entities such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid services (CMS). Hospitals not complying with these regulations are at risk for either financial or accreditation punition. Inpatient AMS have reported positive impacts on patient outcomes in the literature, which gives hospitals an additional impetus to provide this type of service. Inpatient AMS pose many challenges, including identification of resources for development and implementation of the service, means to make changes to the service as it evolves and effectively tracking performance of the service. Using a well-planned, methodical approach for implementation has helped our institution capitalize on the numerous potential benefits of an inpatient AMS, including improved inpatient anticoagulation therapy, improved transitions of care and enhanced interdisciplinary practices.

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Establishing an inpatient anticoagulation service: a step by step review

Cited by 2 publications

References 9 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

Challenges and benefits of an inpatient anticoagulation service: one hospital’s experience

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