Clinical pharmacy input into anticoagulant therapy is now a widely accepted part of clinical practice in many hospitals.
Anticoagulant services
Clinical pharmacy
input into anticoagulant therapy is now a widely accepted part of clinical
practice in many hospitals. Some anticoagulant services were initially set up
as collaborative ventures with medical staff, but pharmacists now manage many
services. Although the exact nature of services provided by the pharmacist may
vary slightly from hospital to hospital, the role of the pharmacist in
anticoagulation has been clearly established: (1) ensuring complete
documentation and referral information is present; (2) interviewing patients
and assessing factors that may affect anticoagulant control, particularly
disease states and drug interactions; (3) monitoring and adjusting anticoagulant
doses to maintain the international normalised ratio within agreed therapeutic
targets; (4) identifying clinical problems that require referral to a
physician; (5) patient counselling and education; (6) providing a regular point
of contact for patients with concerns about their treatment; (7) day-to-day
clinic management training and education for physicians and pharmacists; and
(8) research and audit. Clinical pharmacists can provide high-quality
cost-effective anticoagulant services for both hospital inpatients and
outpatients. Evaluations of services provided show that pharmacist
anticoagulant control is at least as good as, and in some cases better than,
that achieved by medical staff. However, the introduction of new oral
antithrombin and Xa inhibitors, which do not require the same level of
laboratory monitoring, are increasingly likely to offer a viable alternative to
these traditional anticoagulant services.
In more recent
years, the use of anticoagulants for prevention of venous thromboembolism (VTE)
has become much more important as the risks to patients have become better
recognised. NICE published a clinical guideline on VTE across all adult
specialties in January 2010. In England, from April 2010, the national
Commission for Quality and Innovation payment frame-work includes reducing
avoidable death, disability and chronic ill health from VTE as one of two
national goals. These documents seek to ensure that appropriate risk
assessments have been carried out on admission to hospital so that patients can
be identified for thromboprophylaxis, and mechanical measures, where necessary.
This is not restricted to those involved in anticoagulant services and so
clinical pharmacists from all disciplines will play a significant part in
ensuring compliance with the national guidance. The particular contribution
that pharmacy can make is set out in Venous Thromboembolism Prevention, a
Patient Safety Priority, published by the Department of Health along with the
All-Party Parliamentary Thrombosis Group.
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