title: Clinical and safety impact of an inpatient pharmacist-directed anticoagulation service.
abstract: BACKGROUND
  Warfarin is implicated in approximately 30% of reported anticoagulant-related errors. In order to improve anticoagulation management and safety, our institution implemented an inpatient Pharmacist-Directed Anticoagulation Service (PDAS).
  
  
  OBJECTIVE
  To evaluate the impact of this service on both transition of care and safety of patients receiving warfarin anticoagulation.
  
  
  METHODS
  Cluster randomized trial.
  
  
  METHODS
  Large, urban teaching hospital and level 1 trauma center.
  
  
  METHODS
  All patients receiving warfarin on two medical and two cardiology units.
  
  
  METHODS
  A PDAS provided dosing, monitoring, and coordination of transition from the inpatient-to-outpatient setting.
  
  
  METHODS
  Endpoints were assessed during hospitalization and 30 days after discharge. Transition of care was considered effective if compliance with all of the transition of care metrics occurred. The transition of care metrics included: appropriate enrollment in the anticoagulation clinic, documented inpatient-to-outpatient provider contact, documented inpatient provider-to-anticoagulation clinic communication and patient follow-up with the anticoagulation clinic within five days of discharge. Safety was measured by the composite endpoint of thromboembolism, major bleeding, or international normalized ratio (INR) ≥5.
  
  
  RESULTS
  This study included 500 patients. Transition of care metric compliance occurred in 73% more patients in the PDAS group (P < 0.001). There was also a 32% reduction in the composite safety endpoint in the PDAS group (P = 0.103). This finding was driven by a reduction in rate of INR ≥5 (P = 0.076).
  
  
  CONCLUSIONS
  Implementation of a PDAS provides a net improvement in quality of care for the patient taking warfarin in the inpatient setting.
authors.affiliation: Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Schillig
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
authors.forename: Michael
authors.initials: M
authors.lastname: Hudson
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Krol
authors.forename: Edward G
authors.initials: EG
authors.lastname: Szandzik
authors.forename: James S
authors.initials: JS
authors.lastname: Kalus
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D016000:Cluster Analysis; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007297:Inpatients; D007857:Leadership; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D061214:Patient Safety; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D024382:Professional Role
chemical_list: D000925:Anticoagulants