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Title EVALUATION OF A PHARMACIST MANAGED INPATIENT ANTICOAGULATION SERVICE |
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Type Free Paper Session 5 |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Basic Science |
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Main Author Daniel Fletcher1 |
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Presenting Author Daniel Fletcher1 |
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Co-Author |
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Department / Institution / Country Pharmacy / Changi General Hospital / Singapore1 |
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Objective(s) This study is to evaluate the effectiveness of the pharmacists led inpatient anticoagulation (IPAC) service compared to physicians at Changi General Hospital (CGH). |
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Material and Method This is a retrospective cohort study carried from November 2012 to December 2013. The IPAC service only titrates warfarin and International Normalised Ratio (INR) is used to gauge for titration. Existing IPAC cases for the study period were compared against warfarin cases which were physician managed only. Sunrise Clinical Manager (SCM) was used to tabulate the patients’ INR readings. Outcome measures were: 1) Percentage of INR in the therapeutic range within 5 days, 2) Average time to therapeutic INR, 3) Percentage of INR within therapeutic range on discharge and first follow-up and 4) Percentage of INR >4.0 and >5.0. T-test from the Statistical Package for Social Sciences (SPSS) v.21.0 was used for data analysis. |
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Result(s) A total of 71 IPAC cases were compared to 58 physicians managed cases. IPAC had 38 cases achieving therapeutic INR within 5 days compared to 18 cases by physicians (53.5% vs 31%), (p=0.01). Time to therapeutic INR were faster for the IPAC cases compared to physicians (median 3 days, IQR 2-4 days vs median 5 days, IQR 3-8 days), results were statistically significant (p<0.01). IPAC had more therapeutic range INR cases on discharge compared to physicians (52.1% vs 46.6%) but there physician cases within range on first follow up instead (37.6% vs 29.6%). However, both results were not significant (p=0.53 and p=0.317). There were more IPAC cases with INR >4.0 and >5.0 compared to the physicians but this result was not statistically significant (p=0.328 and p=0.343). |
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Conclusion The IPAC service was able to achieve a faster time-to-therapeutic INR compared to physicians with lesser cases of INR >4.0 and >5.0. The service can potentially be utilized to assist physicians to manage warfarin cases. |