​A dosing service or clinic for patients taking warfarin can be a place where physicians, nurses, or pharmacists can provide consistent management of therapy and response. Many patients on warfarin see more than one physician, and it may not always be clear who is managing the warfarin therapy. Plus, physicians have varying amounts of experience managing patients on warfarin. Patients and physicians can both benefit from a dosing service or clinic, which helps to ensure consistency of care, timely evaluation of laboratory results, and prompt response to patients’ anticoagulant needs. The service or clinic can significantly reduce the risk of adverse drug events and improve satisfaction for patients and clinicians.

Tips

• Ensure that all information about a patient’s lab results, dose changes, and responses to therapy is regularly communicated to his or her physician.
• Manage the service or clinic using a nurse practitioner who can adjust doses as needed and communicate the changes to the appropriate physicians.
• Have a nurse or pharmacist, rather than a physician, manage the clinic using your organization’s anticoagulant guidelines or protocols so physicians will not need to be contacted for dose changes.
• Develop a mechanism to identify inpatients that are newly started on warfarin so they can be referred to the service or clinic while still in the hospital.
• Provide patient education about warfarin at the dosing service or clinic to make patients more knowledgeable about managing their therapy at home.