Development and implementation of a pharmacist-managed inpatient anticoagulation monitoring program

Jessica C. Wellman, Peggy S. Kraus, Bradley L. Burton, Christopher R. Ensor, Todd W. Nesbit, Patricia A. Ross, Michelle L. Thomas, Michael B. Streiff

Research output: Contribution to journalArticlepeer-review


Purpose. A stepwise approach to development and implementation of a program to standardize and increase pharmacists' involvement in anticoagulation therapy at a large academic medical center is described. Summary. In response to the Joint Commission's national goal of improved patient safety in anticoagulation therapy, a work group of pharmacy administrators, educators, clinical specialists, and decentralized pharmacists at the hospital developed the structure for a comprehensive inpatient anticoagulation program (IAP); the work group also developed a list of required competencies, educational materials, assessment methods, and mechanisms for eliciting feedback from IAP pharmacists and other patient care staff. After completion of training that included structured case-review sessions, a one-on-one shadowing experience, and competency assessment, IAP pharmacists began reviewing clinical and laboratory data on patients receiving warfarin and low-molecular-weight heparins and providing recommendations to physicians, nurse practitioners, and other health care team members. Feedback from other clinicians was generally positive, with a majority of those surveyed indicating that increased pharmacist involvement in anticoagulation monitoring and dosage adjustment resulted in improved patient care; about 80% indicated that they concurred with pharmacists' recommendations at least 75% of the time. Results of a survey of IAP pharmacists indicated increased satisfaction with their daily duties but also a need for improved pharmacist-to-pharmacist communication. Conclusion. Case-based advanced training and implementation of an IAP in a tertiary care hospital increased pharmacists' involvement in the management of inpatients receiving anticoagulants.

Original languageEnglish (US)
Pages (from-to)934-939
Number of pages6
JournalAmerican Journal of Health-System Pharmacy
Issue number10
StatePublished - May 15 2011


  • Anticoagulants
  • Communication
  • Dosage
  • Heparins
  • Job satisfaction
  • Patient care
  • Pharmaceutical services
  • Pharmacists, hospital
  • Pharmacy, institutional, hospital
  • Toxicity
  • Warfarin

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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