Implementing anticoagulation management by pharmacists in the inpatient setting

Purpose. This article identifies approaches for implementing an inpatient anticoagulation program involving pharmacists; two successful inpatient anticoagulation programs previously reported in the literature are described with a discussion of steps to consider in developing or expanding such a service. Summary. Two institutions implemented pharmacist-managed anticoagulation services. One institution identified an undesirable incidence of medication-related adverse events occurring in hospitalized patients receiving anticoagulants. Pharmacists were asked to assist. Pharmacist activities included the selection of anticoagulants, patient education, verification of insurance coverage of the patient's anticoagulant, and coordination of follow-up. Physicians were available to assist. At the other institution, the department of pharmacy was asked by the orthopedic surgeons to manage warfarin for the prophylaxis against venous thromboembolism. The pharmacy department worked with the medical staff to gain approval of all policies, guidelines, and protocols to establish an anticoagulation service. Because of the success of the program, the pharmacy department expanded the service beyond warfarin. The steps to establishment of an anticoagulation service are described. The challenges facing such programs are discussed, including the potential anticoagulants in development that will create ongoing challenges in deciding which anticoagulation approach to use and in identifying patients for whom the newer agents may or may not be best suited. Conclusion. Requirements for establishing a successful inpatient anticoagulation management program included defining the pharmacist's role in identifying patient needs, gaining support from other health care professionals, designing a program that addresses the needs of the patients, and managing unanticipated issues.