Successful Implementation of a Pharmacist Anticoagulant Dosing Service in Ambulatory Care

Aim To assess the effectiveness of a pharmacist anticoagulant dosing service in an ambulatory care program at an Australian hospital. Method A pre‐ and post‐intervention study method was used. The pre‐intervention group consisted of patients admitted for anticoagulation to the Hospital‐in‐the‐Home program from September 2009 to January 2010, where warfarin was managed by doctors from the treating unit. The post‐intervention group consisted of patients enrolled in the pharmacist dosing service from February 2010 to October 2010. Eligibility criteria for enrolment in the pharmacy dosing service included: admission to the Hospital‐in‐the‐Home program for anticoagulation; warfarin dosing initiated in line with the existing hospital anticoagulation guidelines (modified to accommodate a pharmacist dosing service); medical unit consent for patient inclusion; and patients able to undergo daily INR blood tests. Results The mean number of days for a patient to achieve 2 consecutive therapeutic international normalised ratios was 8.8 days for the pharmacist dosing service (n = 35) and 11.8 days for the pre‐intervention group (n = 53) (p = 0.002). There was no difference in the mean number of international normalised ratios measured between the two groups. Conclusion A pharmacist anticoagulant dosing service effectively managed warfarin dosing in patients admitted to an ambulatory care program.