title: Development and implementation of a pharmacist-managed inpatient anticoagulation monitoring program.
abstract: PURPOSE. A stepwise approach to development and implementation of a program to standardize and increase pharmacists' involvement in anticoagulation therapy at a large academic medical center is described. SUMMARY. In response to the Joint Commission's national goal of improved patient safety in anticoagulation therapy, a work group of pharmacy administrators, educators, clinical specialists, and decentralized pharmacists at the hospital developed the structure for a comprehensive inpatient anticoagulation program (IAP); the work group also developed a list of required competencies, educational materials, assessment methods, and mechanisms for eliciting feedback from IAP pharmacists and other patient care staff. After completion of training that included structured case-review sessions, a one-on-one shadowing experience, and competency assessment, IAP pharmacists began reviewing clinical and laboratory data on patients receiving warfarin and low-molecular-weight heparins and providing recommendations to physicians, nurse practitioners, and other health care team members. Feedback from other clinicians was generally positive, with a majority of those surveyed indicating that increased pharmacist involvement in anticoagulation monitoring and dosage adjustment resulted in improved patient care; about 80% indicated that they concurred with pharmacists' recommendations at least 75% of the time. Results of a survey of IAP pharmacists indicated increased satisfaction with their daily duties but also a need for improved pharmacist-to-pharmacist communication. CONCLUSION. Case-based advanced training and implementation of an IAP in a tertiary care hospital increased pharmacists' involvement in the management of inpatients receiving anticoagulants.
authors.affiliation: Ambulatory Care and Anticoagulation Management, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. wellma2@jhmi.edu
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Wellman
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Kraus
authors.forename: Bradley L
authors.initials: BL
authors.lastname: Burton
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ensor
authors.forename: Todd W
authors.initials: TW
authors.lastname: Nesbit
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ross
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Thomas
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
mesh_terms: D000046:Academic Medical Centers; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D019538:Health Care Surveys; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007588:Job Satisfaction; D008991:Monitoring, Physiologic; D019982:Organizational Case Studies; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role; D016730:Program Development; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin