title: Inpatient Oral Anticoagulation Management by Clinical Pharmacists: Safety and Cost effectiveness.
abstract: BACKGROUND
  Warfarin prescription for anticoagulation after cardiac surgery has always been a challenge for junior medical staff.
  
  
  METHODS
  A prospective study was carried out to assess the quality of anticoagulation control by junior doctors compared with clinical pharmacists at South Manchester University hospitals NHS Trust. The junior medical staff prescribed warfarin for 50 consecutive patients from April to September 2006 (group A, n = 50) and experienced clinical pharmacists dosed 46 consecutive patients between February and May 2007 (group B, n = 46).
  
  
  RESULTS
  In group A, 9 (18%) patients discharge was delayed because of lack of attainment of therapeutic International Normalised Ratio (INR) compared to 3 (6.5%) in group B. The total number of bed days resulting from the delay in group A was 21 compared to 4 in group B. Extrapolated over a year this would amount to approximately 15,750 extra cost incurred in group A opposed to 3000 in group B.
  
  
  CONCLUSIONS
  The pharmacists were significantly better than junior doctors in achieving therapeutic INR, resulting in fewer discharge delays. The clinical pharmacists with experience in outpatient anticoagulation clinic can play an important role in inpatient oral anticoagulation management in post cardiac surgery patients thereby providing improved cost effective quality of care.
  
  
  BACKGROUND
  Warfarin; Pharmacist; Management.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester, Wythenshawe, Manchester, UK.
authors.forename: Sharath R
authors.initials: SR
authors.lastname: Hosmane
authors.forename: Johanna
authors.initials: J
authors.lastname: Tucker
authors.forename: Dave
authors.initials: D
authors.lastname: Osman
authors.forename: Steve
authors.initials: S
authors.lastname: Williams
authors.forename: Paul
authors.initials: P
authors.lastname: Waterworth