Anticoagulant Toxicity, Safety Issues
Conditions
Brief summary
Initiative to improve direct anticoagulant utilization involving programmatic review by clinical pharmacists in collaboration with multidisciplinary team.
Detailed description
The Hadassah Hebrew University Medical Centers' Clinical Pharmacy team initiated a hospital-wide program, in collaboration with the institutions' coagulation specialists, including two hematologists and a clinical pharmacologist, for monitoring and promoting safe and effective prescription of direct oral anticoagulants (DOAC) during hospitalization. Electronic medical records throughout the hospital are screened for DOAC orders. All DOAC orders are assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem is identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance is provided by coagulation specialists. Consultations are recorded in the electronic medical record. Performance measures are collected and summarized.
Interventions
OTHERClinical Pharmacist Medication Review
Programmatic review of physician orders for direct anticoagulants by clinical pharmacists.
Sponsors
Hadassah Medical Organization
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Patients hospitalized in Hadassah Medical Center with a physician's order for direct oral anticoagulants (apixaban, rivaroxaban, or dabigatran).
Exclusion criteria
Patients hospitalized in departments without computerized physician order entry.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of clinical pharmacist consultations accepted by attending physician. | At forty-eight months | Calculated by dividing the number of clinical pharmacist consultations accepted, by the number of clinical pharmacist consultations given, during the period. Data for consultation counts will be obtained from patient electronic medical record. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of clinical pharmacist consultations accepted by attending physician. | At six months | Calculated by dividing the number of clinical pharmacist consultations accepted, by the number of clinical pharmacist consultations given, during the period. Data for consultation counts will be obtained from patient electronic medical record. |
Countries
Israel
Contacts
Primary ContactAmichai Perlman, Pharmd
Outcome results
None listed