Clinical Outcomes and Pharmacists' Acceptance of a Community Hospital's Anticoagulation Management Service Utilizing Decentralized Clinical Staff Pharmacists

2009 ◽  
Vol 43 (4) ◽  
pp. 621-628 ◽  
Author(s):  
Anita Airee ◽  
Alexander B Guirguis ◽  
Rima A Mohammad
Keyword(s):  
Patient Safety ◽  
Medical Care ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Anticoagulation Therapy ◽  
Patient Specific ◽  
Management Service ◽  
Anticoagulation Management ◽  
Major Barrier ◽  
Anticoagulation Management Service

Background: In 2008, the Joint Commission released an updated National Patient Safety Goals document that requires institutions to implement practices that reduce the likelihood of patient harm associated with use of anticoagulation therapy. One of the expectations associated with this goal was that each organization would establish an anticoagulant management program. To our knowledge, few data exist to describe the implementation and assessment of anticoagulation programs in smaller, nonteaching community hospitals using decentralized pharmacists in an integrated practice model. Objective: To compare the performance of a protocol-driven anticoagulation management service led by decentralized pharmacists in a nonteaching community hospital with that of usual medical care provided by hospitalist physicians before this program was implemented. Based on these results, as well as a pharmacist satisfaction survey, evaluate the service and identify barriers to expansion. Methods: We conducted a retrospective cohort study comparing 50 consecutive patients who were starting warfarin for the first time beginning in November 2003 with 50 patients managed by hospitalist physicians prior to November 2002 (the time of program implementation). Results: There were no significant differences between groups with regard to time in therapeutic range once therapeutic, length of stay, international normalized ratios (INRs) greater than 3.5, or INRs less than 2. Patients in the pharmacy management group had significantly fewer drug interactions with antimicrobials than did the usual medical care group. Although time to therapeutic range was longer in the pharmacy protocol group, there were fewer patients with INRs greater than 3.5, although this did not reach statistical significance. Conclusions: The efficacy of the pharmacist-led anticoagulation management service was no different from that of usual medical care. Patient safety appeared improved, in part due to more careful initial dose selection based on patient-specific factors. Although this program was accepted by pharmacists, time limitations were perceived to be a major barrier to quality care and expansion of the service.

scholarly journals The Ottawa Hospital Regional Warfarin Anticoagulation Management Service. Efficacy and a Patient Satisfaction Survey

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3517-3517
Author(s):  
Dimitrios Scarvelis
Keyword(s):  
Patient Satisfaction ◽  
Therapeutic Range ◽  
Oral Anticoagulants ◽  
Satisfaction Survey ◽  
Management Service ◽  
Anticoagulation Management ◽  
Ottawa Hospital ◽  
Patient Satisfaction Survey ◽  
Number Of Patients ◽  
Anticoagulation Management Service

Background: 5% of the population over 65 is on oral anticoagulant therapy. The indications for anticoagulation therapy are wide, not limited to but including treatment of arterial and venous thrombosis, and primary stroke prophylaxis is patients with atrial fibrillation and mechanical cardiac valves. While new oral anticoagulants not requiring monitoring are being more widely prescribed, vitamin K antagonists (VKA) are still being used for many patients in whom the novel agents are contra-indicated (renal failure), not available (funding), or patient/physician preference. Most patients on VKA have their family physicians manage their oral anticoagulants. On average, the time in therapeutic range achieved by family physicians is low (50-55%). There is also a number of patients who have no family physician and are either taking VKA without monitoring, or are having their anticoagulants monitored routinely though emergency room physicians/visits. The Ottawa Hospital (TOH) anticoagulation management service is an e-health solution that offers patients world beating time in therapeutic range (TIR). TOH uses a pharmacy managed DAWN software package (computer-assisted warfarin dosing program). Maintaining patients in therapeutic range for a high percentage of time (greater than 70%) can reduce the risk or recurrent thrombosis (venous or arterial) from under-anticoagulation and the risk of bleeding complications from over-anticoagulation. Well managed VKA therapy has also been suggested to be as safe as therapy with novel oral anticoagulants in some subgroup analysis of studies investigating the novel oral anticoagulants. Objectives/Methods: The purpose of this study was to bring the benefits of the TOH experience to provide a Regional Anticoagulation Management Service across a wide region of eastern Ontario, Canada. This service includes remote blood testing (at a lab near the patient’s home), integrated LIS link to a computerized dosing system (possible through a commercial lab partnership), and communication of dosing and testing instructions via interactive voice recognition (IVRS), email, or live (pharmacist/pharmacist assistant). We administered a patient satisfaction survey to a sample of 111 patients enrolled in the service as well as reported TIR for patients enrolled in our service during the study period (2009-2011). Results: At the beginning of the study, 1400 patients were enrolled in the program. After 2 years, the number has increased to by 66% to 2325. The average TIR for patients in the program as of October 2011 was 76.3% (overall), 77.8% (IVRS), 76.8% (email), and 73.3% (live). The patient satisfaction survey demonstrated that 94% patients prefer VKA anticoagulation monitoring through TOH service compared to their previous experience. 84% patients either satisfied or very satisfied with VKA anticoagulation care through TOH service (compared to 53% satisfaction with anticoagulant care prior to enrolling in our program). Conclusions: The TOH model of anticoagulation management service results in excellent VKA monitoring (high TIR) for a large number of patients across a wide geographical area, as well as a high level of patient satisfaction. This service allows for the safe and efficient management of VKAs in patients in whom VKA therapy is indicated. Disclosures No relevant conflicts of interest to declare.

Clinical and economic benefits of an anticoagulation management service (AMS) for cardiac surgery patients

2007 ◽  
Vol 25 (1) ◽  
pp. 129-129 ◽  
Author(s):  
Paula J. Biscup-Horn ◽  
Michael B. Streiff ◽  
Timothy R. Ulbrich ◽  
Todd W. Nesbit ◽  
Kenneth M. Shermock
Keyword(s):  
Cardiac Surgery ◽  
Economic Benefits ◽  
Management Service ◽  
Anticoagulation Management ◽  
Anticoagulation Management Service

Abstract P97: Operational Redesign of an Outpatient Anticoagulation Management Program- The Vanderbilt Experience

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Jeffrey B Boord ◽  
Wendy S Leutgens ◽  
Keith B Churchwell
Keyword(s):  
Patient Safety ◽  
Information Systems ◽  
Anticoagulation Therapy ◽  
Steering Committee ◽  
Quality Metrics ◽  
Management Program ◽  
Anticoagulation Management ◽  
Therapy Assessment ◽  
Anticoagulation Clinics ◽  
National Patient

The 2008 Joint Commission National Patient Safety Goals required healthcare organizations to adopt practices to reduce the likelihood of harm associated with use of anticoagulation therapy. Assessment of our anticoagulation programs in 2008 demonstrated gaps that did not meet these new requirements. Patients were enrolled in two large anticoagulation clinics (separately managed by pharmacy and cardiology) with smaller programs linked to their clinical service lines. Identified gaps included: separate programs that were not standardized and had no integrated governance/oversight, inadequate budget and staffing models to meet growing demand, lack of unified practice policy and anticoagulation information systems, and lack of standardized quality measures and reporting. Vanderbilt leadership commissioned an Anticoagulation Executive Steering Committee to perform an operational redesign of the anticoagulation programs to meet National Patient Safety Goals. The committee appointed working groups to: evaluate and redesign clinical operations and finance, perform a technology assessment to develop standard anticoagulation information systems, and develop standardized reporting of quality metrics. The key redesign features were: 1) merging of the existing anticoagulation clinics into a single unified program; 2) dedicated institutional budget for ambulatory anticoagulation services with costs shared across the clinical enterprise; 3) implementation of standard policies and protocols for anticoagulation management and education; 4) creation of dedicated oral anticoagulation management software (AMS) fully integrated into the electronic health record; 5) creation of medical director and program manager positions for operational oversight of the unified program, and an Anticoagulation Oversight Committee for clinical practice supervision; 6) development of a bundle of quality metrics and operational/clinical data reports derived from the AMS. Our redesign experience provides a blueprint for other organizations that provide anticoagulation management to meet National Patient Safety Goals.

Performance Measurement of a Pharmacist-Directed Anticoagulation Management Service

2001 ◽  
Vol 36 (11) ◽  
pp. 1164-1169 ◽  
Author(s):  
Jon C. Schommer ◽  
David A. Mott ◽  
Philip J. Schneider ◽  
Karen R. Knoell
Keyword(s):  
Performance Measurement ◽  
Management Service ◽  
Anticoagulation Management ◽  
Anticoagulation Management Service
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