Survey of pharmacist-managed inpatient anticoagulation services

The scope of existing pharmacist-managed inpatient anticoagulation services and the roles and responsibilities of the pharmacists involved were studied.

A general query regarding the provision of inpatient anticoagulation services was sent by e-mail to members of the American College of Clinical Pharmacists practice and research networks for cardiology, critical care, and general internal medicine. Those individuals whose institutions had such services were sent a written questionnaire and asked to describe the scope of the services provided. Data collected included a description of the type of service model and the management strategies for seven different antithrombotic agents: warfarin, unfractionated heparin, low-molecular-weight heparin, fondaparinux, argatroban, lepirudin, and bivalirudin. Survey results were entered into a database and sent to all participants for use as a resource.

Of the 33 respondents to the initial e-mail, 25 completed the written questionnaire. A variety of service models were used, most of which were developed and implemented within the past seven years. The majority of services (92%) were consultation based, many of which incorporated daily pharmacist rounds. Less than half of the services were under the supervision of a physician, and only four services involved a multidisciplinary team. In addition, the management of individual antithrombotic agents varied between services, including the automatic management of all patients receiving targeted agents, strict institution-specific protocols, and general guidelines. All but one service provided educational opportunities for students and residents.

Inpatient anticoagulation services described by survey respondents varied in design, structure, and level of responsibility of pharmacists.