Background: In cardiac care hospital, several medications are used that falls in category of High Alert Medications. Anti-coagulants are drugs that are included in this list because of various drug-drug interactions, therapeutic drug monitoring and adverse drug event associated with the use of these drugs. Upon reviewing literature, it is also evident that anticoagulants are class of medications most frequently leads to emergency room visits and hospital admissions. Pharmacist involvement in such program can significantly reduce harm to patients.
Aims: The program plan to achieve the following aims:
o To ensure the safe and effective use of anticoagulants use in hospital.
o To minimize the adverse drug events reported using these drugs.
o To minimize the Readmissions after the inappropriate use of anticoagulants.
o To improve Monitoring and education of patients on warfarin.
Methods: The data of INR from Jan2020 – June 2020 (six month) was collected from laboratory. Which shows 65% patients reported with sub therapeutic < 1.9 INR, 11% patients were identified with supra therapeutic INR > 4 and 24% population were within therapeutic range. 8 patients were admitted in Emergency due to warfarin toxicity.
Results: Based on above data a quality improvement project on development of anticoagulation stewardship program was proposed to pharmacy and therapeutic committee. The clinical pharmacist led ASP approved, in this program during admission pharmacist will review the medications for appropriateness, at the time of discharge pharmacist will be responsible for warfarin teaching and then follow up in outpatient clinic for INR monitoring. Pharmacist are closely working with cardiologist, in case of emergency contact the primary physician.
Conclusion(s): Due to the complexity of warfarin management ,clinical pharmacist led ASP program will play major role in INR monitoring , reduce emergency admissions and enhancing medication compliance.
To cite this abstract in AMA style:khan S, qureshi M, jahangir A. Development of clinical pharmacist led Anticoagulation stewardship program in cardiac care setting in developing country. [abstract]. https://abstracts.isth.org/abstract/development-of-clinical-pharmacist-led-anticoagulation-stewardship-program-in-cardiac-care-setting-in-developing-country/. Accessed September 29, 2023.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/development-of-clinical-pharmacist-led-anticoagulation-stewardship-program-in-cardiac-care-setting-in-developing-country/