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

Fowler, Sara; Gulseth, Michael P.; Renier, Colleen M.; Tomsche, James J

doi:10.2146/ajhp110015

Cited by 13 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Having pharmacists monitor these patients throughout therapy and until completion of treatment allows for interventions to be made when issues arise. [12][13][14][15] Due to the complexity involved in managing therapy, the Joint Commission (TJC) has challenged hospitals to reduce the likelihood of patient harm associated with the use of anticoagulant therapy through the National Patient Safety goals. Presently, our institution has made great strides to attain these goals but ongoing effort is essential to maintain and exceed the expectations put forth by TJC.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Padrón

Miyares

2013

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Pharmacist-directed anticoagulation management services (AMSs) have been shown to significantly lower anticoagulation-related mortality, length of hospital stay, bleeding complications, blood transfusion requirements, and cost of therapy. AMSs are only 1 component of an anticoagulation stewardship program. Frequently, stewardship programs are limited to inpatient populations. Incorporating components that facilitate transition to outpatient status will ideally encompass complete care. The purpose of this program was to expand anticoagulation services and standardize care by implementing a full-service stewardship program including a transition of care service. The first component of the study involved medication surveillance for inpatients on anticoagulation therapy. The second component involved transitioning patients on anticoagulation, primarily with venous thromboembolism (VTE) to outpatient management. Finally, the pharmacist identified areas for optimization. Optimization involved developing or updating protocols to reflect updates in the literature as well as updating institution-specific information resources. Interventions made through medication surveillance and utilization of the VTE transition of care services translated into a total cost savings of approximately US$270 320. A postgraduate, first-year pharmacy resident contributed to improving patient outcomes while reducing utilization of hospital services and obtaining substantial cost savings through participation in anticoagulation stewardship services.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Having pharmacists monitor these patients throughout therapy and until completion of treatment allows for interventions to be made when issues arise. 12 -15…”

Section: Introductionmentioning

confidence: 99%

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

Padrón

Miyares

2013

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…National pain management organizations, including the American Pain Society, have identified pharmacists as potential members of an interdisciplinary team‐based approach for optimizing pain management . A variety of pharmacist‐led monitoring services, including nutrition support, anticoagulation management, antimicrobial dosing, immunosuppression, and pain management, has previously been described in the literature …”

Section: Introductionmentioning

confidence: 99%

Implementation of a Pharmacist‐Led Patient‐Controlled Analgesia Dosing Service

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Recent studies have detailed efforts by hospitals to improve the care of these patients. [1][2][3][4][5][6] To determine best practices and assess performance of inpatient anticoagulation, there is a need for a standardized approach to identify bleeding. No gold standard exists as an optimal way to measure bleeding events among hospitalized patients.…”

mentioning

confidence: 99%

Going Beyond Administrative Data: Retrospective Evaluation of an Algorithm Using the Electronic Health Record to Help Identify Bleeding Events Among Hospitalized Medical Patients on Warfarin

et al. 2016

View full text Add to dashboard Cite

To reliably assess quality, a standardized electronic approach is needed to identify bleeding events. The study aims were the following: (1) clinically validate an electronic health record-based algorithm for bleeding and (2) assess interrater results to determine validity and reliability. Data were analyzed before and after implementation of a pharmacist-managed warfarin protocol. Bleeding was based on ≥2 of 3 criteria: (1) diagnosis indicating bleeding, (2) lab value decrease suggesting bleeding, and (3) blood product use. All suspected bleeds (234) and a sample (58) not meeting criteria were compared with clinical review. There were 234 bleeding cases identified electronically. Reviewer agreement was 78.2% (κ = 0.565). Algorithm sensitivity was 93.9% and positive predictive value 46.2%. Algorithm identification was least accurate for those with only 2 criteria but good for those with all criteria. This study supports using multiple electronic criteria to identify bleeding events. However, cases having exactly 2 criteria may require manual review for validation.

show abstract

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

Abstract: The evaluation of outcomes of the inpatient-based AMS at SMMC provided critical information to the anticoagulation subcommittee for consideration of quality-improvement efforts.

Cited by 13 publications

References 8 publications

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

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

Implementation of a Pharmacist‐Led Patient‐Controlled Analgesia Dosing Service

Going Beyond Administrative Data: Retrospective Evaluation of an Algorithm Using the Electronic Health Record to Help Identify Bleeding Events Among Hospitalized Medical Patients on Warfarin

Contact Info

Product

Resources

About