Clinical Pharmacist Anticoagulant Stewardship

Hadassah Medical Organization4,000 enrolled

Overview

Initiative to improve direct anticoagulant utilization involving programmatic review by clinical pharmacists in collaboration with multidisciplinary team.

The Hadassah Hebrew University Medical Centers' Clinical Pharmacy team initiated a hospital-wide program, in collaboration with the institutions' coagulation specialists, including two hematologists and a clinical pharmacologist, for monitoring and promoting safe and effective prescription of direct oral anticoagulants (DOAC) during hospitalization. Electronic medical records throughout the hospital are screened for DOAC orders. All DOAC orders are assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem is identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance is provided by coagulation specialists. Consultations are recorded in the electronic medical record. Performance measures are collected and summarized.

Study Type

OBSERVATIONAL

Enrollment

4,000

Conditions

Safety Issues Anticoagulant Toxicity

Interventions

Clinical Pharmacist Medication ReviewOTHER

Programmatic review of physician orders for direct anticoagulants by clinical pharmacists.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: Patients hospitalized in Hadassah Medical Center with a physician's order for direct oral anticoagulants (apixaban, rivaroxaban, or dabigatran). Exclusion Criteria: Patients hospitalized in departments without computerized physician order entry.

Locations (1)

Hadassah Medical Organization, Jerusalem, Israel

Jerusalem, Israel

RECRUITING

Outcomes

Primary Outcomes

Percent of clinical pharmacist consultations accepted by attending physician.

Calculated by dividing the number of clinical pharmacist consultations accepted, by the number of clinical pharmacist consultations given, during the period. Data for consultation counts will be obtained from patient electronic medical record.

Time frame: At forty-eight months

Secondary Outcomes

Percent of clinical pharmacist consultations accepted by attending physician.

Time frame: At six months

Central Contacts

Amichai Perlman, Pharmd

CONTACT

972505172768 amichaip@hadassah.org.il

Data from ClinicalTrials.gov

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