title: The scope and value of an anticoagulation stewardship program at a community teaching hospital.
abstract: To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings. The PCC analysis was conducted via retrospective chart review during the pre-intervention period. Prospective monitoring continued in the post-intervention period to determine the percentage of PCC use within the institution's guidelines or approved by ACT or hematology. A total of 19,445 patient charts were reviewed, and 1930 (10%) contained stewardship opportunity. Of the interventions, 71% were provided to the medical service and 22% to surgical services with acceptance rates of 91 and 83%, respectively. Intervention cost-avoidance calculated to be $694,217. Regarding HIT interventions, 52% of interventions involved pharmacokinetic/pharmacodynamics optimization in 18 patients with suspected or confirmed HIT. Regarding PCC use, 55.8% of PCC orders were considered inappropriate in the pre-invention period versus 2.6% post-intervention. Appropriate PCC doses per month post-intervention were consistent with pre-intervention doses (7.67 vs. 6.73, respectively). The projected annual PCC cost savings is $385,473. The overall estimated financial impact of ACT is $799,690 saved. Implementation of an anticoagulation stewardship program reduced costs and improved clinical outcomes. It is also expected that anticoagulant optimization and provider education improved overall safety.
authors.affiliation: Department of Pharmacy and Hematology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA. Maura.wychowski@rochesterregional.org.
authors.forename: Maura K
authors.initials: MK
authors.lastname: Wychowski
authors.affiliation: Department of Pharmacy and Hematology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA.
authors.forename: Christina I
authors.initials: CI
authors.lastname: Ruscio
authors.affiliation: Department of Pharmacy and Hematology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kouides
authors.affiliation: Department of Pharmacy and Hematology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Sham
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D019468:Disease Management; D005260:Female; D006405:Hematology / Q000193:education; D006764:Hospitals, Community / Q000191:economics / Q000379:methods / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D008297:Male; D010595:Pharmacists; D011446:Prospective Studies; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy / Q000191:economics
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates
keywords: Anticoagulation stewardship; Hospital; Pharmacist; Prothrombin complex concentrates; Reversal agents