Impact of atrial fibrillation and oral anticoagulation on hospital costs and length of stay.

Am J Health Syst Pharm. 2012 Feb 15;69(4):329-38

Authors: Song X, Sander SD, Johnson BH, Varker H, Amin AN

Abstract
PURPOSE: The results of a study assessing hospital length of stay (LOS) and inpatient costs associated with nonvalvular atrial fibrillation (AF) and AF-related warfarin use during hospitalization are presented.
METHODS: Managed care administrative claims data were used to construct cohorts of patients hospitalized with AF as a primary (n = 1,868) or secondary (n = 11,200) discharge diagnosis and control groups of patients with similar demographics and clinical characteristics who were hospitalized during the same period (2002-07). Multivariate regression analyses were performed to estimate the incremental impact of AF on hospital LOS and costs per admission, as well as the incremental impact of in hospital warfarin use on the evaluated LOS and cost outcomes.
RESULTS: The cohort of patients with AF as a secondary discharge diagnosis had a mean LOS 1.84 days greater (p < 0.001) and a mean hospital costs $3,146 higher (p < 0.001) than the control cohort; in hospital warfarin use in those patients was associated with a mean increase in LOS of 1.45 days (p < 0.001) and a mean increase in hospital costs of $1,761 per admission (p < 0.001). In the cohort of patients with AF as a primary discharge diagnosis, inpatient warfarin therapy was also associated with longer hospital stays (mean increase, 1.26 days; p < 0.001) and higher hospital costs (mean increase, $678; p = 0.031).
CONCLUSION: Hospitalizations of patients with a secondary diagnosis of AF are significantly longer and more costly than those of patients without a secondary diagnosis of AF, especially when warfarin is used during the hospital stay. Among patients with a primary diagnosis of AF, warfarin therapy during hospitalization is associated with significant increases in mean LOS and hospital costs.

PMID: 22302258 [PubMed - indexed for MEDLINE]

Fidaxomicin: A novel macrocyclic antibiotic for the treatment of Clostridium difficile infection.

Am J Health Syst Pharm. 2012 Jun 1;69(11):933-43

Authors: Crawford T, Huesgen E, Danziger L

Abstract
Purpose The pharmacology, clinical efficacy, safety, dosage and administration, and place in therapy of fidaxomicin for the treatment of Clostridium difficile infection (CDI) are reviewed. Summary Fidaxomicin, a macrocyclic antibiotic, has a narrow spectrum of activity against gram-positive anaerobes and is bactericidal against C. difficile. It has no activity against gram-negative bacteria. Fidaxomicin has minimal activity against Bacteroides species, which may be advantageous in maintaining colonization resistance and protecting the gastrointestinal tract from colonization by C. difficile. The minimum inhibitory concentration for 90% of organisms for fidaxomicin against C. difficile ranged from 0.0078 to 2 ?g/mL in in vitro studies. After oral administration, fecal concentrations are detected and are directly proportional to the dose administered. Fidaxomicin resistance in vivo has not been reported. In clinical trials, fidaxomicin has been shown to be noninferior to vancomycin in the management of mild-to-moderately severe CDI. The adverse-effect profile of fidaxomicin is comparable to that of vancomycin. The recommended dosage for treatment of CDI is fidaxomicin 200 mg orally twice daily for 10 days. Fidaxomicin should be considered for patients who previously received treatment with metronidazole or vancomycin for CDI and who are diagnosed with recurrent CDI in which a non-NAP1/BI/027 strain is isolated. At institutions where strain typing is not available, fidaxomicin may be considered in patients with recurrent CDI who have not responded to treatment with the regimen used for the first episode of CDI. Conclusion Fidaxomicin is a well-tolerated agent for the treatment of CDI and has been shown to be noninferior to vancomycin in the management of mild-to-moderately severe CDI.

PMID: 22610025 [PubMed - in process]

Performance of a vancomycin dosage regimen developed for obese patients.

Am J Health Syst Pharm. 2012 Jun 1;69(11):944-50

Authors: Reynolds DC, Waite LH, Alexander DP, Deryke CA

Abstract
Purpose An original and a revised vancomycin dosing protocol for obese patients were compared with respect to attainment of target serum trough vancomycin concentrations and the occurrence of nephrotoxicity. Methods The attainment of target vancomycin trough values (10-20 ?g/mL) and nephrotoxicity were compared retrospectively between an original protocol (vancomycin 15 mg/kg i.v. every 8-12 hours), which had been associated with high troughs, and a revised protocol (10 mg/kg i.v. every 12 hours or 15 mg/kg every 24 hours). Patients were included if they were obese (weight ? 100 kg and total body weight ? 140% of ideal body weight), had normal renal function (creatinine clearance ? 60 mL/min), had received i.v. vancomycin for at least 48 hours, and had one evaluable vancomycin trough value. Nephrotoxicity was defined as an increase in serum creatinine concentration of 0.5 mg/dL or of 50% over baseline, whichever was greater. Results Seventy-four and 64 patients were stratified into groups that had been treated with the revised and original protocols, respectively. The mean ± S.D. maintenance dose was 19 ± 2 mg/kg/day with the revised protocol and 34 ± 7 mg/kg/day with the original protocol (p < 0.001). Compared with the original protocol, the revised protocol resulted in a higher frequency of target troughs (59% versus 36%, p = 0.006) and below-target troughs (23% versus 9%, p = 0.033) and a lower frequency of above-target troughs (18% versus 55%, p < 0.001). Nephrotoxicity occurred in two patients in each group. Conclusion Compared with the original vancomycin protocol for obese patients, a revised vancomycin protocol using lower total daily doses improved the attainment of target trough concentrations, with minimal nephrotoxicity.

PMID: 22610026 [PubMed - in process]

High-dose argatroban for treatment of heparin-induced thrombocytopenia with thrombosis: A case report and review of laboratory considerations.

Am J Health Syst Pharm. 2012 Mar 15;69(6):490-5

Authors: Hellwig TR, Peitz GJ, Gulseth MP

Abstract
Purpose A case report describing high-dose argatroban for the treatment of heparin-induced thrombocytopenia (HIT) with thrombosis and associated considerations in interpreting laboratory monitoring data are presented. Summary A 51-year-old woman with an extensive history of coronary artery disease arrived at the emergency department with complaints of chest pain. The patient was admitted, and coronary artery bypass graft surgery was ultimately performed. The patient had a baseline platelet count of 177,000 cells/?L. During hospitalization, the patient received heparin, and her platelet count dropped to 12,000 cells/?L 13 days after the initiation of heparin. The patient developed swelling around a peripherally inserted central catheter and later developed deep vein thrombosis. An argatroban infusion of 2 ?g/kg/min was initiated, with a target activated partial thromboplastin time (aPTT) of 40-80 seconds. After 5 days of therapy, the patient had increased swelling in her right arm and an aPTT of 56 seconds. Her goal aPTT was subsequently increased. Six days later, the patient developed a left-lower-extremity DVT despite aPTTs within the goal range. A new aPTT target of >75 seconds was set. The infusion rate was increased to 15.5 ?g/kg/min to attain the target aPTT. Results of an in vitro test led to an alternative interpretation of aPTT and International Normalized Ratio values that aided in the monitoring of argatroban during the high-dose infusion. Conclusion A patient with HIT with thrombosis was successfully treated with unusually high dosages of argatroban and may have had serum argatroban concentrations exceeding what has commonly been thought to be the therapeutic range.

PMID: 22382479 [PubMed - in process]

Preventing venous thromboembolism in hospitalized patients with cancer: Improving compliance with clinical practice guidelines.

Am J Health Syst Pharm. 2012 Mar 15;69(6):469-81

Authors: Brown A

Abstract
Purpose The use of anticoagulants for the prevention of venous thromboembolism (VTE) in hospitalized medical and surgical oncology patients is discussed. Summary Hospitalized patients are often at risk for developing VTE, and risk is increased in patients who have cancer. Moreover, the incidence of VTE appears to be rising in hospitalized cancer patients, who have a 2.2-fold increased risk of mortality with a VTE compared with similar patients without VTE. The literature indicates that these patients are often inadequately anticoagulated, despite strong recommendations for prophylaxis. Although there are few studies that specifically address VTE prophylaxis in cancer patients, there are several large trials that have examined data in cancer subgroups. The trials have directly compared low-molecular-weight heparin (LMWH) with placebo, unfractionated heparin with LMWH, factor Xa inhibitor (fondaparinux) with placebo, and fondaparinux with LMWH. Three important guidelines provide current recommendations for VTE prophylaxis; the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the American College of Chest Physicians (ACCP) recommend unfractionated heparin, LMWH, or fondaparinux for VTE prophylaxis when there are no contraindications. Pharmacists can play an essential role in ensuring that VTE prophylaxis is appropriate for individual patients. Interventions to improve compliance with guidelines are particularly important now due to financial incentives from quality-focused organizations whose mandate is to decrease preventable mortality events in hospitals. Conclusion Hospitalized patients with cancer often do not receive appropriate thromboprophylaxis. Guidelines from ASCO, ACCP, and NCCN recommend unfractionated heparin, an LMWH, or fondaparinux for VTE prophylaxis when there are no contraindications to such therapy.

PMID: 22382477 [PubMed - in process]

Implementation of targeted interventions to decrease antiretroviral-related errors in hospitalized patients.

Am J Health Syst Pharm. 2012 Mar 1;69(5):422-30

Authors: Daniels LM, Raasch RH, Corbett AH

Abstract
Purpose The implementation and effectiveness of targeted interventions aimed at decreasing the frequency of antiretroviral-related errors in hospitalized patients with human immunodeficiency virus (HIV) are described. Summary A prospective investigation conducted at the University of North Carolina Hospitals revealed a high rate of antiretroviral-related errors occurring on admission to the hospital and throughout a patient's hospital stay. The high frequency of errors emphasized the need for targeted interventions aimed at preventing these errors and quickly identifying and resolving errors that do occur. Several interventions aimed at decreasing this error rate were instituted, including the addition of computer alerts for incorrect doses and drug interactions to the pharmacy order-entry system, distribution of an educational pocket-sized card among the staff, addition of commercially available combination antiretroviral products to the hospital formulary, updates of the computerized prescriber-order-entry (CPOE) system to include common dosage defaults, involvement of the infectious diseases consultation service to evaluate prescribed regimens of newly admitted patients with HIV, and daily review of newly initiated anti-retroviral regimens by a clinical pharmacist trained in HIV care. A follow-up analysis was conducted after these interventions were implemented to evaluate their effectiveness. Of the 78 patients identified during the postintervention analysis, 12 (15%) had at least one error in their initial drug regimen versus 49 patients (72%) in the preintervention study (p < 0.001). Conclusion Antiretroviral medication error rates decreased after the implementation of targeted interventions that included distributing an educational pocket-sized card, adding alerts to the pharmacy order- entry system, incorporating default dosages into the CPOE system, and adding combination antiretrovirals to the formulary.

PMID: 22345421 [PubMed - in process]

Initiative to improve thromboprophylactic enoxaparin exposure in hospitalized patients with renal impairment.

Am J Health Syst Pharm. 2012 Mar 1;69(5):390-6

Authors: Elsaid KA, Collins CM

Abstract
Purpose The impact of a quality-improvement (QI) initiative to decrease the risk of bleeding in renally impaired patients receiving enoxaparin prophylaxis for venous thromboembolism (VTE) was evaluated. Methods A retrospective cohort with a before-and-after study design was employed. Inclusion criteria included age over 40 years, hospitalization exceeding six days, treatment with enoxaparin or unfractionated heparin (UFH), and acute or chronic renal insufficiency. Major bleeding included fatal bleeding, symptomatic bleeding requiring hemodynamic support or causing a decrease of 2 g/dL or more in hemoglobin concentration, or bleeding leading to the transfusion of at least 2 units of packed red blood cells. The QI intervention restricted enoxaparin use in patients with a creatinine clearance (CL(cr)) concentration of <30 mL/min and recommended UFH instead. Results The rate of major bleeding in the preintervention group was 13.5% with enoxaparin compared with 4.1% with UFH (p = 0.005). The relative risk (RR) of bleeding with enoxaparin compared with UFH was 3.21 (95% confidence interval [CI], 1.40-7.34). In patients with a CL(cr) concentration of <30 mL/min, the RR of bleeding with enoxaparin compared with UFH was 4.68 (95% CI, 1.06-20.59). The rate of major bleeding in the postintervention period was 9.5% with enoxaparin or 4.5% with UFH (p = 0.15). The RR of bleeding in the postintervention period was 0.64 (95% CI, 0.37-1.12). Conclusion A QI initiative that eliminated the use of enoxaparin for prophylaxis of VTE in patients with renal impairment resulted in lower rates of major bleeding associated with pharmacologic prophylaxis. No differences in the rate of inhospital VTE as a result of the intervention were observed.

PMID: 22345418 [PubMed - in process]

Determining vancomycin clearance in an overweight and obese population.

Am J Health Syst Pharm. 2011 Apr 1;68(7):599-603

Authors: Leong JV, Boro MS, Winter M

Abstract
PURPOSE: Two methods of calculating vancomycin clearance were compared to determine the best body weight measure to use when dosing vancomycin for overweight and obese patients.
METHODS: Hospitalized veterans weighing more than 120% of their ideal body weight (IBW) with serum vancomycin concentrations (SVCs) drawn between January 1, 2003, and June 30, 2005, were eligible for study inclusion. Exclusion criteria included weight of more than 300% the IBW, unstable renal function, dialysis, uncertain vancomycin dosing or sampling times, and distribution-phase sampling. Data from January 1 through December 31, 2003 (phase 1) determined the best-fit weight for vancomycin clearance for the Leonard and Boro method. The bias and precision of the modified Leonard and Boro method using the best-fit weight for vancomycin clearance were then compared with those of the Rushing and Ambrose method for predicting SVCs from January 1, 2004, through June 30, 2005 (phase 2).
RESULTS: Forty-eight patients were included in phase 1, with 67 SVCs for analysis. During phase 1, adjusted body weight (ABW), using the Leonard and Boro method, was superior in predicting vancomycin clearance and the resultant SVCs. A total of 96 patients were included in phase 2 of the study, with 160 SVCs for analysis. The modified Leonard and Boro method was significantly more precise than the Rushing and Ambrose method in predicting vancomycin clearance.
CONCLUSION: Use of ABW proved to be superior compared with total body weight when estimating vancomycin clearance in overweight and obese patients. While there was no difference in bias between methods, the modified Leonard and Boro method was significantly more precise than the Rushing and Ambrose method in predicting SVCs when dosing vancomycin for obese patients.

PMID: 21411801 [PubMed - indexed for MEDLINE]

Comparison of rates of reported adverse events associated with i.v. iron products in the United States.

Am J Health Syst Pharm. 2012 Feb 15;69(4):310-20

Authors: Bailie GR

Abstract
Purpose An analysis of reported adverse events (AEs) among patients using i.v. iron products, including the newer agent ferumoxytol, is presented. Methods All AE reports to the Food and Drug Administration (FDA) citing iron sucrose, ferric gluconate, high- and low-molecular-weight iron dextran products, or ferumoxytol from October 2009 through June 2010 were evaluated. The rates of various classifications of reported AEs were calculated on a per-unit-sold basis and, for comparison of products supplied in different unit sizes, also in terms of 100-mg dose equivalents (DEq) of iron. Results A total of 197 reported AEs were identified (a cumulative rate of 14.1 AEs per million units sold). The rates of all AE classifications combined ranged from 5.25 to 746 per million units sold for iron sucrose and ferumoxytol, respectively; using the other method of calculation, the rates ranged from 5.24 per million DEq (iron sucrose) to 147 per million DEq (ferumoxytol). Relative to iron sucrose and sodium ferric gluconate, ferumoxytol was associated with significantly elevated risks of death (odds ratio [OR], 475 and 156, respectively; p < 0.0001), serious nonfatal AEs (OR, 263 and 121, respectively; p < 0.0001), and all evaluated AE classifications combined (OR, 142 and 109, respectively; p < 0.05). Conclusion Analysis of reports submitted to FDA revealed large differences among i.v. iron products in reported deaths, serious AEs, other major AEs, and other AEs. Iron sucrose and sodium ferric gluconate were associated with much lower rates of AEs per million units sold than iron dextran or ferumoxytol, which were associated with the highest rates of all reported AE classifications.

PMID: 22302256 [PubMed - in process]

Development and implementation of a comprehensive heparin-induced thrombocytopenia recognition and management protocol.

Am J Health Syst Pharm. 2012 Feb 1;69(3):241-8

Authors: Smythe MA, Mehta TP, Koerber JM, Forsyth LL, Sykes E, Corbets LR, Melendy SM, Parikh R

Abstract
Purpose A quality initiative to improve the management of heparin-induced thrombocytopenia (HIT) at an academic medical center, including the development of guidelines on the use of direct thrombin inhibitors (DTIs), is described. Summary In keeping with the Joint Commission's National Patient Safety Goal (NPSG) for anticoagulant therapy (goal 03.05.01), a multidisciplinary working group conducted a needs assessment to identify areas for improvement in the center's HIT management practices, particularly the use of DTI therapy (an issue not specifically addressed by NPSG 03.05.01). The resulting action steps included (1) the implementation of a detailed protocol for the recognition and management of HIT, as well as guidelines on the use of the DTIs argatroban and lepirudin, (2) more efficient use and optimized documentation of initial and confirmatory tests in the electronic medical record (EMR), and (3) the education of pharmacists, nurses, and physicians on the use of the HIT protocol, with initial and ongoing case-based competency testing of pharmacy staff. Early postimplementation experience indicated that the protocol and associated activities have resulted in improved DTI prescribing and dosing, HIT documentation, and patient education practices while expanding pharmacists' involvement in ensuring optimal, cost-effective management of patients with HIT. Conclusion In one institution, an HIT working group extended the scope of NPSG 03.05.01 to include the parenteral DTIs. The implementation of the HIT protocol has resulted in greater compliance with appropriate DTI dosing and improved EMR documentation of HIT.

PMID: 22261947 [PubMed - in process]

Aztreonam lysine for inhalation: New formulation of an old antibiotic.

Am J Health Syst Pharm. 2012 Jan 15;69(2):107-15

Authors: Zeitler K, Salvas B, Stevens V, Brown J

Abstract
Purpose The pharmacology, safety, efficacy, pharmacokinetics, pharmacodynamics, current place in therapy, and potential future therapeutic uses of inhaled aztreonam are reviewed. Summary Inhaled aztreonam, a newly formulated lysine salt of the original monobactam antibiotic, is approved for the treatment of respiratory symptoms in patients with cystic fibrosis (CF) who are colonized with Pseudomonas aeruginosa. Its spectrum of activity is limited to susceptible gram-negative organisms, including P. aeruginosa. Lyophilized aztreonam lysine is diluted with 0.17% sodium chloride and administered using the Altera nebulizer system, which produces appropriate-sized particles for proper deposition in the lungs to achieve high sputum and low systemic concentrations. Mean sputum drug concentrations are highest 10 minutes after dose administration, and plasma concentrations peak one hour after inhalation. Aztreonam is excreted via active tubular secretion and glomerular filtration. Caution is advised in patients with renal or hepatic impairment, breastfeeding women, and patients age 65 years or older. Like the older i.v. formulation, inhaled aztreonam displays time-dependent killing. Phase III clinical trials have shown improvements in respiratory symptoms, decreased P. aeruginosa sputum density, prolonged time intervals between antibiotic treatments, and efficacy without the development of resistance in the face of repeated exposures. This formulation is available only from select specialty pharmacies and should only be used with the Altera nebulizer system. Conclusion Inhaled aztreonam has shown efficacy and safety in patients seven years of age or older with CF who have P. aeruginosa airway infections. This product may complement existing therapies and offers the advantage of a new inhaled formulation to aid in treatment regimens.

PMID: 22215356 [PubMed - in process]

Inpatient warfarin: Experience with a pharmacist-led anticoagulation management service in a tertiary care medical center.

Am J Health Syst Pharm. 2012 Jan 1;69(1):44-8

Authors: Fowler S, Gulseth MP, Renier C, Tomsche J

Abstract
Purpose The implementation of a pharmacist-led anticoagulation management service (AMS) and the clinical outcomes of inpatients receiving warfarin management are described. Summary An AMS was established at St. Mary's Medical Center (SMMC) in Duluth, Minnesota, in November 2003 at the request of orthopedic surgeons to manage warfarin for their patients postoperatively. The AMS was also available to other inpatients by physician request. All AMS pharmacists received didactic and experiential training. Each day, the managing pharmacist, usually the decentralized pharmacist, was responsible for checking the patients' International Normalized Ratio (INR); reviewing other pertinent laboratory test values, any medication changes, and vital signs; monitoring changes in the patients' clinical status, and writing an order for a warfarin dose. A database was created to help monitor patients managed by the AMS and to analyze monthly outcomes data. Clinical outcomes data were evaluated to identify areas of improvement for the AMS. All hospitalizations for patients who received anticoagulation therapy with warfarin managed by the AMS from January 1, 2006, through August 31, 2007, were analyzed. Primary endpoints, including thrombosis and bleeding complications during hospitalization, were identified for inclusion in the final hospital discharge data. Of the 2794 hospitalizations for patients managed by the AMS evaluated, 59 complications were identified. Of these, 14 (0.5%) were thrombosis events and 45 (1.6%) were bleeding events. INR results were also analyzed as secondary endpoints. Conclusion The evaluation of outcomes of the inpatient-based AMS at SMMC provided critical information to the anticoagulation subcommittee for consideration of quality-improvement efforts.

PMID: 22180551 [PubMed - in process]

New treatment options for acute edema attacks caused by hereditary angioedema.

Am J Health Syst Pharm. 2011 Nov 15;68(22):2129-38

Authors: Thomas MC, Shah S

Abstract
Purpose New treatment options for acute edema attacks caused by hereditary angioedema (HAE) are reviewed. Summary HAE is characterized by mutations in the C1 inhibitor gene leading to either a reduced expression of C1 inhibitor in the plasma or expression of a functionally impaired C1 inhibitor. HAE is classified into two major types based on the cause of the C1 inhibitor deficiency. Type I HAE is defined by a reduced expression of C1 inhibitor in the plasma, whereas type II HAE is characterized by the expression of a dysfunctional C1 inhibitor protein. Clinical data were reviewed for C1 inhibitor, ecallantide, and icatibant in the treatment of acute edema attacks caused by HAE. C1 inhibitor leads to a faster onset of edema relief and is effective in decreasing the duration of edema. Dosing strategies include fixed dosing and weight-based dosing. Optimal dosing strategies have not been established, but fixed dosing (500-1000 units) or 20 units/kg has been effective in clinical trials and reports. No comparative trials suggest that one strategy is superior to another; however, the approved labeling for acute treatment is based on weight. Ecallantide is also efficacious for treating acute episodes; however, the available evidence is limited to a single published trial. Icatibant has shown variable effects in two trials with placebo and active controls. Conclusion In patients with HAE, most edema episodes only involve the skin and gastrointestinal tract, though airway obstruction caused by laryngeal angioedema is the most common cause of death. I.V. C1 inhibitor should be considered first-line treatment for acute edema attacks because of its fast onset of action and effective-ness, though it is not clear whether fixed or weight-based dosing is preferred. Ecallantide can be considered as a second-line treatment option.

PMID: 22058099 [PubMed - in process]

Improving adherence to best-practice guidelines for venous thromboembolism risk assessment and prevention.

Am J Health Syst Pharm. 2011 Nov 15;68(22):2184-8

Authors: Schiro TA, Sakowski J, Romanelli RJ, Jukes T, Newman J, Hudnut A, Leonard T

Abstract
Purpose The effectiveness of a program to improve adherence to best-practice guidelines for venous thromboembolism (VTE) risk assessment and prevention in a community hospital setting was evaluated. Summary Variation in the use of best-practice guidelines for VTE risk assessment and prevention with regard to the frequency of VTE risk assessment and the risk score assigned, as well as the communication of the risk of VTE and the need for prophylaxis to treating physicians, was found. To improve adherence to established guidelines, the responsibilities of a nurse case manager were expanded to serve as a single point of contact who was accountable for identifying high-risk patients and advocating for appropriate pharmacologic prophylaxis in the absence of contraindications. To facilitate the role of the nurse case manager, an automated VTE-risk-assessment tool was developed to reliably identify high-risk patients in real time. This intervention was evaluated from January 1 to June 30, 2010. Before the intervention, contraindications to anticoagulation were reported for 19.1% of high-risk patients not receiving prophylaxis and pharmacologic prophylaxis was ordered for 47.9% of high-risk patients without contraindications. During the course of the intervention, contraindications to anticoagulation were reported for 36.2% of high-risk patients not receiving prophylaxis and pharmacologic prophylaxis was ordered for 64.9% of high-risk patients without contraindications. Conclusion The appointment of a nurse case manager trained in anticoagulation and the development of an automated VTE-risk-assessment tool to identify patients at high risk of VTE were associated with improved adherence to best-practice guidelines for VTE risk assessment and prevention.

PMID: 22058105 [PubMed - in process]

Implementation of an inpatient anticoagulation teaching service: Expanding the role of pharmacy students and residents in patient education.

Am J Health Syst Pharm. 2011 Nov 1;68(21):2086-93

Authors: Wilhelm SM, Petrovitch EA

Abstract
Purpose The implementation of and early experience with an anticoagulation teaching service managed by pharmacy students and residents are described. Summary A structured anticoagulation teaching program was established to improve the provision of education services to inpatients scheduled for discharge home on anticoagulant therapy (consistent with the Joint Commission's National Patient Safety Goal 03.05.01). The program served patients at three affiliated institutions and was designed to supplement pharmacists' usual anticoagulation education activities. After completing supervised training in anticoagulation education and documentation procedures, pharmacy students and residents on rotation at the facilities staffed the service three days per week for five hours per day. In the first five months of operation, the teaching service significantly increased the rate of anticoagulation patient education (to 59.2%, compared with 39.1% during a specified five-month preimplementation period; p < 0.0001). Among patients educated through the teaching service, 60-day readmission rates for both anticoagulation-related and nonanticoagulation-related problems were lower than readmission rates among patients not receiving the structured education services. Conclusion Implementing an anticoagulation teaching service provided by pharmacy students and residents significantly increased the rate of patient education and lowered readmission rates.

PMID: 22011988 [PubMed - in process]