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.