Clinical Pharmacy Forum
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Service or Program:
A multidisciplinary team redesigned Community Health Network’s anticoagulation clinic processes to integrate clinical pharmacists to improve patient safety, efficiency, and quality of care. As part of this new workflow, pharmacists are responsible for management of perioperative anticoagulation. A provider will enter an order to hold oral anticoagulation and either assess or defer assessment to pharmacist for subcutaneous anticoagulation bridging. The pharmacist will then review the orders for appropriateness and contact provider if there are any issues or further recommendations per clinical guidelines. Finally, the pharmacist is responsible for developing and communicating instructions to the patient.
Justification/Documentation: Integrating pharmacists provided an innovative solution for the network’s identified need for improvement in patient safety and satisfaction regarding perioperative anticoagulation management. After pharmacists began providing this service, both patient safety outcomes and communication among providers improved significantly. Over 6 months, pharmacists identified that 28 of 133 (21%) procedure bridge orders were potentially inappropriate with a 75% provider acceptance rate of recommendations for no anticoagulation bridging. Furthermore, pharmacists are able to intervene in situations where anticoagulation bridging was deemed unsafe, such as history of heparin-induced thrombocytopenia, dialysis, and previous gastrointestinal bleeding.
Adaptability: In outpatient settings where pharmacists are integrated into anticoagulation management, this service could be a valuable addition to improve safety and satisfaction for patients undergoing procedures. Ambulatory care pharmacists are uniquely qualified to assess and manage perioperative anticoagulation therapy as well as provide education.
Significance: Pharmacists’ responsibilities were expanded to include high-level decision making regarding the necessity of holding warfarin and bridging based on patient- and procedure-specific bleeding and thrombotic risks. The pharmacists ensure that a perioperative plan is appropriate, the plan is communicated effectively to the patient, and potential barriers to bridging are addressed. Additionally, interdisciplinary teamwork is promoted through contact with nursing staff and providers in coordinating the perioperative plan as needed.
Presenting Author
Taylor Hibner PharmDAuthors
Lindsey Greiner PharmD
Community Health Network
Tiffany Vatterrodt PharmD
Community Health Network