Warfarin: a quality assurance model for concurrent drug monitoring

Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.