Development and implementation of a pharmacist-managed inpatient warfarin protocol

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Internal Medicine

Background:

• Warfarin administration presents complexities and bleeding risks.
• Current clinical guidelines and evidence-based medicine inform warfarin management.
• Pharmacist-led protocols may optimize warfarin therapy.

Purpose of the Study:

• To evaluate clinical outcomes of a pharmacist-managed warfarin protocol.
• To compare pharmacist management with usual physician care.
• To assess the safety and efficacy of pharmacist-led warfarin administration.

Main Methods:

• A pilot study compared a pharmacist-managed warfarin protocol with usual physician care.
• Twenty-nine patients were enrolled in the protocol group and 22 in the control group.
• Data collected included time to therapeutic range, adverse drug reactions, and supratherapeutic international normalized ratios.

Main Results:

• Both groups achieved therapeutic warfarin ranges within 6 days.
• Pharmacist-managed patients showed a trend toward fewer adverse drug reactions (7% vs. 14%).
• Pharmacist-managed patients also trended toward fewer supratherapeutic international normalized ratios (17% vs. 27%).

Conclusions:

• Pharmacist-managed warfarin administration demonstrated a trend towards improved safety outcomes.
• While not statistically significant in this pilot, results align with larger studies on pharmacist effectiveness.
• The protocol's availability was expanded at Baylor University Medical Center based on these findings.