Anticoagulation Interventions by Pharmacists in Acute Care

Area of Science:

• Clinical Pharmacy
• Pharmacoeconomics
• Patient Safety

Background:

• Clinical pharmacy key performance indicators (cpKPIs) are vital for improving patient outcomes.
• Saskatchewan Health Authority (SHA) Regina integrates cpKPIs into clinical practice standards, guiding care for high-risk medications like anticoagulants.
• The AIM High electronic data-capture system was implemented to monitor pharmacists' interventions related to these standards.

Purpose of the Study:

• To quantify and describe pharmacists' anticoagulation interventions across 16 wards.
• To compare anticoagulation intervention rates between cardiology and internal medicine wards.
• To inform the evolution of the organization's clinical practice model for anticoagulation management.

Main Methods:

• Retrospective analysis of data from the AIM High electronic data-capture system.
• Data collected over a 5-year period (January 2016 to December 2020).
• Interventions were categorized and compared between cardiology and internal medicine wards.

Main Results:

• A total of 94,201 interventions were recorded, with 15,661 (16.6%) related to anticoagulation standards.
• Anticoagulation interventions averaged 60 per week, or 4 per pharmacist per week.
• The most common interventions included dose changes (27.9%), starting/restarting medications (24.7%), patient education (19.8%), and discontinuing medications (18.8%).

Conclusions:

• Dedicated ward-based clinical pharmacists effectively utilized clinical practice standards for anticoagulation interventions.
• The nature of anticoagulation interventions demonstrated an evolution over time, influenced by patient populations.
• The findings support the integration of cpKPIs and clinical practice standards in anticoagulation management.