Successful Implementation of a Pharmacist Anticoagulant Dosing Service in Ambulatory Care

Dooley, Michael; McGuiness, Josephine; Choo, Shin; Ngo‐Thai, Lam‐Lan; Tong, Erica; Neave, Katrina; Poole, Susan; Street, Alison

doi:10.1002/j.2055-2335.2011.tb00863.x

Cited by 2 publications

(2 citation statements)

References 20 publications

(38 reference statements)

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“…In 2011, an Australian study in Melbourne described the success of a pharmacist-led anticoagulant dosing service within an Australian HITH program [ 64 ]. Patients achieved a therapeutic INR faster when warfarin dosing was managed by a pharmacist compared to a doctor.…”

Section: Benefits Of Pharmacist Involvementmentioning

confidence: 99%

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

2020

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Clinic- and hospital-based home care describes models of care where services commonly associated with hospital inpatient care are provided at the patient’s home or in an outpatient or community-based clinic. Hospital in the Home (HITH), also termed Hospital at Home (HaH) in parts of Europe and America, is a common and important example of this type of care. Other examples include infusion centers, skilled nursing facilities (particularly in the USA), self-administration models (including home infusion services) and administration through outpatient or community clinics. Different models of HITH care are used internationally and these encompass a wide range of services. Medication administration, particularly outpatient parenteral antimicrobial therapy (OPAT), is an important element in many of these models of care. There is a key role for pharmacists since the provision of medication is integral in this model of patient care outside the hospital setting. Data on the growing importance of HITH and OPAT as well as the administration of medications suited to clinic- and hospital-based home care, including subcutaneous and intramuscular injectables, immunoglobulins and other blood fractions, cancer chemotherapy, total parenteral nutrition, biologicals/biosimilars, vasopressors and enzymes, using differing service models, are described. The pharmacist’s role is evolving from that involved primarily with dose preparation and supply of medications. Their clinical expertise in medication management ensures that they are an integral member and leader in these models of care. Their role ensures the safe and quality use of medicines, particularly across transitions of care, with the pharmacist taking on the roles of educator and consultant to patients and health professional colleagues. Activities such as antimicrobial stewardship and ongoing monitoring of patients and outcomes is fundamental to ensure quality patient outcomes in these settings.

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Section: Benefits Of Pharmacist Involvementmentioning

confidence: 99%

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

2020

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“…Several recent Australian studies have demonstrated partnered pharmacist charting of medicines to be safe and effective in reducing medication‐related errors in areas such as orthopaedics, the emergency department and general medicine . Partnered pharmacist anticoagulant prescribing in an Australian ambulatory care Hospital In The Home (HITH) program, reduced time to reach therapeutic INR and facilitated earlier discharge back to community care …”

Section: Introductionmentioning

confidence: 99%

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

Tyedin

Taylor

Than

et al. 2020

Pharmacy Practice and Res

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Aim: To evaluate whether pharmacist-assisted electronic warfarin charting and monitoring reduces warfarin-related errors and improves post-discharge continuum of care. Method: Cardiology and medical patients admitted for at least 24 h and prescribed at least one warfarin dose were included in a pre/post-intervention study. The intervention involved pharmacists proactively charting warfarin and ordering international normalised ratios (INRs) using electronic prescribing software, following discussion with medical doctors. Endpoints included: percentage of patients with one or more warfarin errors, INR > 5.0 during admission, readmission within 30 days for anticoagulant-related issues and warfarin discharge plan (WDP) completeness (including documentation of next dose/s, and when and where the next INR was to be checked). Results: Pre-and post-intervention groups comprised 130 and 108 patients, respectively. Post-intervention, more patients received warfarin following heart valve replacement and fewer for venous thromboembolism. Post-intervention, pharmacists ordered 130 doses (72 patients) and 98 INRs (59 patients). Percentage of patients with one or more warfarin errors declined from 27.7 to 7.4% (p < 0.01), with INR> 5.0 decreased from 7.7 to 2.8% (p = 0.17) and readmission within 30 days for anticoagulation problems occurred in 4 and 0 cases pre-and post-intervention, respectively. While there was a non-significant decline in the proportion of patients with a WDP post-intervention, when patients had a WDP it was more comprehensively completed (p < 0.01). Conclusion: Pharmacists proactively charting and monitoring warfarin reduced warfarin-related errors during hospitalisation and improved elements of post-discharge communication. Closer multi-disciplinary communication and 7-day pharmacy services may result in further continuum of care improvements.

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Successful Implementation of a Pharmacist Anticoagulant Dosing Service in Ambulatory Care

Abstract: Aim:To assess the effectiveness of a pharmacist anticoagulant dosing service in an ambulatory care program at an Australian hospital.

Cited by 2 publications

References 20 publications

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

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

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