When pharmacists manage an anticoagulation service, they assume all responsibility for implementation and maintenance of anticoagulant therapy. Physician orders determine that the patient will receive the therapy and specify the desired range for the International Normalized Ratio (INR) value. But pharmacists determine the appropriate initial dose and then review clinical information daily to determine whether adjustments are needed. Allowing pharmacists to manage an anticoagulation service results in greater efficiency for pharmacists, nurses, and physicians, who don’t have to spend time making phone calls to report lab values or check for changes in dosing orders. The pharmacists make adjustments to the dose in a more timely fashion — a benefit to the patient that reduces the chance of an adverse drug event.
Tips
- Test the process of a pharmacist-managed anticoagulation service with one physician at first to demonstrate the benefits and generate support from other physicians.
- Ensure that pharmacists have timely access to INR values, ideally through electronic notification.
- Coordinate the service with outpatient anticoagulation programs or clinics.
- Make a plan for handling anticoagulants during off-shifts if your organization does not have a pharmacist on duty 24 hours a day.
