Clinical Pharmacist Anticoagulant Stewardship

Overview

Initiative to improve direct anticoagulant utilization involving programmatic review by clinical pharmacists in collaboration with multidisciplinary team.

Full Title of Study: “Clinical Pharmacist Led Hospital-Wide Direct Oral Anticoagulant Stewardship Program”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: January 1, 2020

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

  • Other: Clinical Pharmacist Medication Review
    • Programmatic review of physician orders for direct anticoagulants by clinical pharmacists.

Clinical Trial Outcome Measures

Primary Measures

  • Percent of clinical pharmacist consultations accepted by attending physician.
    • Time Frame: 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 Measures

  • Percent of clinical pharmacist consultations accepted by attending physician.
    • Time Frame: 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.

Participating in This Clinical Trial

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.

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hadassah Medical Organization
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Mordechai Muszkat, MD, Principal Investigator, Hadassah University Medical Center
  • Overall Contact(s)
    • Amichai Perlman, Pharmd, 972505172768, amichaip@hadassah.org.il

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