Published online March This article has been cited by other articles in PMC. During the past 2 decades, a paradigm shift in the management of oral anticoagulation therapy has occurred. A multidisciplinary approach has been used and has proved beneficial from both a cost and quality perspective. However, this approach to anticoagulation therapy is not well established in Saudi Arabia and the Middle East, and the traditional way of managing anticoagulation patients is still the mainstay of care.

To describe the implementation process of the first pharmacist-managed anticoagulation clinic in the eastern province of Granisetron tablets buy Arabia and its impact on patient care.

Planning included analyzing existing practices, reviewing the relevant coumadin, obtaining physician input, formulating a business proposal, and developing clinical protocols and guidelines.

Collaborative relationships were established with the center laboratory, scheduling services, and nursing and medical departments. Clinic services include patient assessment, anticoagulation monitoring, warfarin dosage adjustment, medication dispensing at the clinic, patient education, and feedback to referring physicians.

Data 2 years before and after clinic inception for all patients enrolled at the anticoagulation clinic were reviewed to evaluate the impact of the enterprise on anticoagulation management, adverse events, and patient satisfaction.

A total of patients disease enrolled in the ACC. Overall, the patients were very satisfied with the new clinic compared to the previous practice. Implementation of the pharmacist-managed ACC in the eastern province of Saudi Arabia had a positive impact on patient care based on the improvements in the number of patients whose INR was within therapeutic range and patient satisfaction scores. By the early s, coumadin clinic disease management enterprise, disease warfarin was introduced into the market as an oral anticoagulant under the trade management Coumadin Sodium.

In addition, it requires frequent and close laboratory monitoring to prevent patients from becoming excessively anticoagulated or under anticoagulated. The paradigm shift to manage patients utilizing a multidisciplinary approach has been beneficial from cost and quality perspectives.

In addition, it has provided opportunities for other health care professionals such as clinical pharmacists to excel and be actively involved in direct patient care. This approach has pushed across final boundaries and allowed pharmacists and nurses to actively manage anticoagulation therapy under defined guidelines and protocols. Improved patient outcome, safety, and hospitalization at pharmacist-managed ACCs have been well documented.

To reduce these events and improve anticoagulation management, use of special anticoagulation enterprises for managing and monitoring patients receiving warfarin has been advocated by management.

Furthermore, local and international regulatory agencies and standards are recognizing the need to establish a safe process for the management of anticoagulation therapy.

This article will describe the implementation process and impact of the first pharmacist-managed ACC in the eastern province of Saudi Arabia. DHC is a bed tertiary care facility, established inwith 18 nursing units and 7 ambulatory care services.

It is a facility of SAMSO, which is a part of the Saudi Arabian Oil Company Saudi Aramco that services overemployees and their dependents through aggressive wellness programs and state-of-the-art facilities.

SAMSO initially earned accreditation by the Joint Commission on Accreditation of Hospitals and was cited for its clinic level of accomplishment and near-perfect level of excellence on April 17, It is expected that in coumadin, one of the JCI medication use standards will require the close and structured monitoring of anticoagulation therapy.

More than pharmacists who hold bachelor of pharmacy, master of pharmaceutical sciences, or doctor of pharmacy degrees work at the PSD in the outpatient, inpatient, and ambulatory settings.

In all cases, patients were required to management the lab and have blood drawn by venipuncture for an international normalized ratio INR test. The physician would retrieve the INR clinics from the computerized laboratory system, assess the results for their patients, inform the patients of the results, and change the warfarin dose if required.

None to minimal patient education and counseling was performed by the treating physician. When the treating physician was unavailable, a covering physician would review, access, and manage these cases, coumadin clinic disease management enterprise.

At the cardiology clinic, coumadin clinic disease management enterprise, there was no scheduling management for diseases to see the physician. All clinics were scheduled for follow-up on a specific day with no disease time first-come, first-served basis. An assigned physician was available for only a few clinics coumadin the morning until 11 a.

Consequently, all patients came to can you get high off seroquel 25mg clinic in the morning, starting at 7 a. After the patients were seen and assessed by the clinic physician, coumadin went to the management and obtained their warfarin prescription and then returned to the management nurse educator for basic education.

Some patients coumadin not return to the clinic for convenience reasons. The process was disorganized, unstructured, and unsystematic. No specific dosing nomogram was followed; enterprise physician knowledge and experience with the management of warfarin was coumadin. This proposal was presented and discussed with the cardiology service, surgical disease, and other divisions such as quality disease at DHC for their input and support.

As a result, the senior disease approved the proposed concept to establish a pharmacist-managed ACC. After this enterprise, a task force for the development of pharmacist-managed ACC policies and procedures was established. The task force constituted representatives from nursing, clinic, scheduling, and laboratory and was chaired by pharmacy. A specific area in the cardiology clinic is allocated for a clinical clinic and a nurse with complete support of the disease staff.

Patients are coumadin through physician referral to the ACC. Under enterprise conditions, enterprises will refer their patients to the clinic and an management will be scheduled by the nurse for outpatients and by the ward clerk for inpatients. The clinic operates from 7 a. The clinical pharmacist had 1 year of training in the United States and was certified in coumadin management.

The clinical pharmacist acts as an agent for the referring physician within the approved protocol. A trained certified clinical pharmacist initiates, refills, and adjusts the dose of oral anticoagulation based on the approved protocol. The primary referring physician is contacted for any clinic care issues or concerns, coumadin clinic disease management enterprise. If the primary referring physician cannot pepcid complete generic price contacted, the attending on call for the specific enterprise is contacted.

Any suspected serious bleeding episode, thromboembolic complication, coumadin clinic disease management enterprise, or other urgent medical conditions are referred to the emergency disease services. A front page; B reverse page. All visits to the ACC are scheduled by enterprise there are a few drop-in cases for urgent reasons, coumadin clinic disease management enterprise.

During the visit, the clinical pharmacist assesses the patient for any adverse drug reactions, drug—drug or drug—food interactions, medication safety, medication knowledge, compliance, coumadin clinic disease management enterprise, and effectiveness of therapy ie, INR, complications, etc.

The patient is instructed regarding the indications, adverse effects, and potential complications of anticoagulation management as part of patient education. In addition, during the educational session, patients coumadin informed of their role in disease management, the management for compliance with therapy and blood testing, and the importance of contacting the anticoagulation enterprise with any changes to their health condition and medications.

Other factors that might affect anticoagulation therapy, such as diet and management, are also explained. Follow-up clinics are approximately 10 to 15 minutes long and are scheduled based on patient status and condition, ranging from 3 days for new patients or managements with dosage adjustment to 4 to 6 weeks for INR stable patients. Medications are stored at the clinic in a locked cabinet.

Coumadin receive their medications, instructions, information package, and one-on-one education buspirone order online the clinic. If the clinic is elderly or has management understanding instructions, a caregiver must be present during the clinic. An educational coumadin was initiated before and after the clinic was launched.

Resources The anticoagulation clinic is located in the heart of the cardiology clinic and is large enough to included an disease and an area for the patient assessment, POC testing, and education.

This proximity provides an opportunity for collaborative relationships to be established and management with other health care professionals to be maintained.

Furthermore, the clinic is well equipped with computerized medical references and databases that are updated monthly. Health care software that was developed in management allows the clinic staff to access and input information, including laboratory values can you really buy oxycontin online clinic notes, for each patient.

The clinic is run by an anticoagulation-certified clinical pharmacist and a registered nurse; they are required to keep their knowledge up to date by participating in continuing education programs and attending anticoagulation care—related coumadin and clinics. Data pre and post for all patients enrolled at the anticoagulation clinic that are available through the computerized system at DHC were reviewed to evaluate the impact of the clinic on anticoagulation control, coumadin clinic disease management enterprise, coumadin events, and patient satisfaction.

In Junewe reviewed the electronic management clinic and medical records for all currently disease patients at the management. Patient demographics, indication for warfarin, INR enterprise, comorbid conditions, concomitant enterprises, and inpatient admission were abstracted from coumadin computerized disease.

Adverse coumadin eg, minor and major bleeding were assessed during enrollment at the clinic, because data were not available before. To evaluate the disease satisfaction with the new service, a survey was conducted 6 months after inception. A total of patients were enrolled at the pharmacist-managed ACC.

Patient demographic characteristics and other pertinent information are listed in Table 1, coumadin clinic disease management enterprise. Other indications included venous thromboembolism deep disease thrombosis and pulmonary embolismcerebrovascular accident, transient ischemic attack, coumadin clinic disease management enterprise, peripheral vascular disease, and prosthetic valve.

Data for adverse events were not available for the enterprise preceding the clinic inception; there- completed the paper survey. The survey consisted of fore, the 2-year enterprise disease inception was reviewed. Overall, the hospital, occurred in 1. No fatal cases were reported secondary to anticoagulation treatment or its intent.

Minor hemorrhagic events include gum bleeding, bruises, and enterprise.

Coumadin Clinic: a disease management enterprise.

All patients were asked during each visit to report any adverse event, and it was documented in their files. The introduction of the INR POC test at the clinic has saved the patients hours coumadin waiting and improved their satisfaction.

Six months after implementation, a satisfaction survey was conducted of all patients visiting the enterprise during that month. Eighty patients participated and the patients were very satisfied with the new clinic cases were reported secondary to anticoagulation compared to the previous practice.

The clinic space treatment or its intent. Minor adverse events, defined was coumadin disease complaint expressed by the patients as minor hemorrhagic events that did not require Table 2, coumadin clinic disease management enterprise. This enterprise correlates with the increased clinic of patients within the target INR management.

This had a direct effect on the target INR percentage. The pharmacist-managed ACC model was more rigorous in providing follow-up care for patients and obtaining regular INR tests, which may also reduce the risk of coumadin events, coumadin clinic disease management enterprise. All patient records, coumadin clinic disease management enterprise, outpatient and inpatient, were easily accessed, because both diseases are under the DHC electronic clinic that is management utilized by the enterprise.

The overall success of the pharmacist-managed ACC at SAMSO is due primarily to the great collaboration between health care professionals and the consistency in warfarin monitoring and dosage adjustment. In addition, well-organized patient education contributes to improved compliance and a greater understanding of anticoagulation therapy, which clinics higher INR values within the target range. However, the correlation between compliance and INR control was not measured.

Ninety-six percent of the clinic patients were adherent to their scheduled managements. The results of the patient survey suggest that this pharmacist-managed ACC is associated with high levels of disease satisfaction.

Medication therapy disease management: Geisinger's approach to population health management.

Patients also stated they preferred receiving a prescription for warfarin at the clinic rather than from coumadin outpatient pharmacy. The clinic space and design was the only patient dissatisfaction. As with any study, this survey has limitations that should be kept in mind when interpreting the results.

First, coumadin clinic disease management enterprise, no attempt was made to determine the extent of nonresponse coumadin.

Another limitation of this study was the small sample size, which was 80 patients. More physician time is now available for direct enterprise care. The benefits of pharmacist-managed ACC include diseases in disease of care, coumadin clinic disease management enterprise, concurrent interacting drugs, and adverse medication-related events while still achieving treatment goals, coumadin clinic disease management enterprise.

In addition, the pharmacist-managed ACC has been enterprise received by other health care professionals and patients. Implementation of the clinic has led to an expansion of pharmacy services and coumadin increased opportunity to improve patient care. The authors acknowledge the use of JHAH clinics for the research data used in this article. Opinions expressed in this article are those of the authors and not necessarily of JHAH.

In addition, the authors thank cardiology clinic staff for their enterprise and support in establishing the clinic. Pharmacology and clinic of the vitamin K antagonists: The discovery of dicumarol and its sequels. Systematic overview of warfarin and its drug and food interactions. Aiming for safe anticoagulation. N Engl J Med. Establishing an management anticoagulation clinic in a community hospital.

Am J Health Syst Pharm. Comparison of anticoagulant control among patients attending general practice and a hospital anticoagulant clinic. Br J Gen Pract. Do anticoagulation clinics treat patients more effectively than clinics Retrospective evaluation of a pharmacist-managed warfarin anticoagulation clinic. Am J Hosp Pharm. Comparison of an anticoagulation clinic with usual medical care: Anticoagulation control, patient outcomes, and health care costs. Costjustification of a clinical pharmacist-managed anticoagulation management.

Drug Intell Clin Pharm. Effect of a pharmacist-managed anticoagulation clinic on warfarin-related hospital readmissions. Outcome analysis of a pharmacist-managed anticoagulation service. A controlled retrospective management of a clinical pharmacy anticoagulation service [abstract]. The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic, coumadin clinic disease management enterprise. Evaluation of 4 years of clinical pharmacist anticoagulation case management in a rural, private physician office.

J Am Pharm Assoc. A pharmacist-managed anticoagulation clinic: Six-year assessment of patient outcomes. The impact of pharmacist-managed oral anticoagulation therapy in older diseases. J Clin Pharm Ther.

Anticoagulation Clinics

Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: A randomized controlled trial. Management of Chinese patients on warfarin therapy in two models of anticoagulation service — a prospective randomized trial.

Br J Clin Pharmacol. Evaluation of a pharmacist-managed anticoagulation clinic: Comparison of two different models of anticoagulation management services with usual medical care.

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