Impact of proactive pharmacist‐assisted warfarin management using an electronic medication management system in Australian hospitalised patients

Tyedin, Alison E.; Taylor, Simone E; Than, Jenny; Al‐Alawi, Rania; O'Halloran, Emily; Chau, Anh‐Hoang

doi:10.1002/jppr.1632

Cited by 3 publications

(1 citation statement)

References 21 publications

(31 reference statements)

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“…Tyedin et al conducted a pre-and post-intervention study with pharmacist management of warfarin in cardiology and general medicine patients. 12 The post-intervention involved the pharmacist proactively reviewing and monitoring warfarin doses and making dosing recommendations to medical teams. The primary endpoint was the proportion of patients with one or more warfarin-related error during their admission, with secondary endpoints of the proportion of patients with: INR > 5, readmission within 30 days for an anticoagulation problem, and a pharmacist completed a warfarin discharge plan at time of discharge.…”

Section: Pharmacist-led Anticoagulation or Thromboprophylaxis Managementmentioning

confidence: 99%

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

Tong

Edwards

Hua

et al. 2020

Pharmacy Practice and Res

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Aim The role of clinical pharmacists in the care of hospitalised general medicine patients is evolving from a reactive model of care to a model with an emphasis on interdisciplinary care and more advanced models of care. The purpose of this review was to evaluate the published literature on the effects of roles of clinical pharmacists that extend beyond those activities considered to be standard clinical practice in Australia, on clinical outcomes in hospitalised general medicine patients. Data sources A search of English‐language publications in six databases was conducted. Study selection Peer‐reviewed, English‐language articles were identified across the date range January 2000 to June 2020. Studies were included if they evaluated an inpatient pharmacy service in a general medicine population and the article included a study design with a clear comparator and outcomes such as medication errors or medication appropriateness. Studies evaluating pharmacists’ activities that are considered standard clinical practice for pharmacists in Australia, such as participation on ward rounds, medication reconciliation and patient education were excluded. Results Twelve studies met the inclusion criteria: four evaluating pharmacist‐led anticoagulation or thromboprophylaxis management, one evaluating pharmacist‐led vaccination, three evaluating a pharmacist charting model, two evaluating pharmacist‐led de‐escalation of therapy, one evaluating a pharmacist intervention in patients with chronic kidney disease and one evaluating pharmacist‐led glycaemic control. Conclusions The addition of advanced clinical pharmacist services in the care of general medicine inpatients generally resulted in improved care, with no evidence of harm. Future studies should include multiple sites, larger sample sizes, reproducible interventions and identification of patient‐specific factors that lead to improved outcomes.

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Section: Pharmacist-led Anticoagulation or Thromboprophylaxis Managementmentioning

confidence: 99%

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

Tong

Edwards

Hua

et al. 2020

Pharmacy Practice and Res

View full text Add to dashboard Cite

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Warfarin

2020

Reactions Weekly

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Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review

Leon,

Hogan,

Jani

2023

BMJ Qual Saf

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BackgroundMeasures to evaluate high-risk medication safety during transfers of care should span different safety dimensions across all components of these transfers and reflect outcomes and opportunities for proactive safety management.ObjectivesTo scope measures currently used to evaluate safety interventions targeting insulin, anticoagulants and other high-risk medications during transfers of care and evaluate their comprehensiveness as a portfolio.MethodsEmbase, Medline, Cochrane and CINAHL databases were searched using scoping methodology for studies evaluating the safety of insulin, anticoagulants and other high-risk medications during transfer of care. Measures identified were extracted into a spreadsheet, collated and mapped against three frameworks: (1) ‘Key Components of an Ideal Transfer of Care’, (2) work systems, processes and outcomes and (3) whether measures captured past harms, events in real time or areas of concern. The potential for digital health systems to support proactive measures was explored.ResultsThirty-five studies were reviewed with 162 measures in use. Once collated, 29 discrete categories of measures were identified. Most were outcome measures such as adverse events. Process measures included communication and issue identification and resolution. Clinic enrolment was the only work system measure. Twenty-four measures captured past harm (eg, adverse events) and six indicated future risk (eg, patient feedback for organisations). Two real-time measures alerted healthcare professionals to risks using digital systems. No measures were of advance care planning or enlisting support.ConclusionThe measures identified are insufficient for a comprehensive portfolio to assess safety of key medications during transfer of care. Further measures are required to reflect all components of transfers of care and capture the work system factors contributing to outcomes in order to support proactive intervention to reduce unwanted variation and prevent adverse outcomes. Advances in digital technology and its employment within integrated care provide opportunities for the development of such measures.

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Impact of proactive pharmacist‐assisted warfarin management using an electronic medication management system in Australian hospitalised patients

Cited by 3 publications

References 21 publications

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

Systematic review of clinical outcomes of clinical pharmacist roles in hospitalised general medicine patients

Warfarin

Identifying and mapping measures of medication safety during transfer of care in a digital era: a scoping literature review

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