Delivery of Optimized Anticoagulant Therapy: Consensus Statement from the Anticoagulation Forum

David A Garcia, MD; Daniel M Witt, PharmD; Elaine Hylek, MD, Ann K Wittkowsky, PharmD CACP FASHP FCCP; Edith A Nutescu, PharmD FCCP; Alan Jacobson, MD, Director, Anticoagulation Services; Associate Chief of Staff for Research, Loma Linda Veterans Affairs Medical Center, Loma Linda, CA; Stephan Moll, MD; Geno J Merli, MD FACP; Mark Crowther, MD MSc FRCPC; Laura Earl, BSN CACP; Richard C Becker, MD; Lynn Oertel, MS ANP CACP; Amir Jaffer, MD; Jack E Ansell, MD

Disclosures

The Annals of Pharmacotherapy. 2008;42(7):979-988. 

In This Article

Section III: Care Management and Coordination

3.1 Written policies and procedures for the delivery of optimized anticoagulation therapy should be established and approved by the individual who is ultimately responsible for the delivery of anticoagulant care. Policies and procedures should facilitate communication between all parties with a vested interest in the outcomes of anticoagulant therapy.

Policies and procedures serve as a clinical tool and a quality assurance mechanism to reduce variability in the delivery of care.[22] Any individual or dedicated AMS providing OAT should establish policies and procedures that address common and/or controversial issues that may arise ( Table 3 ). Policies and procedures should be reviewed, updated as evidence becomes available, and approved regularly by appropriate committees (eg, a pharmacy and therapeutics or medical executive committee) and should be widely disseminated throughout the organization. These policies and procedures should also include protocols for routine dosing and follow-up determinations and should be available for review within the clinic at all times.

Coordination of anticoagulation therapy requires timely interaction among the anticoagulation providers, referring physicians, surgeons, specialists, dentists, pharmacists, laboratory personnel, skilled nursing facilities, assisted living facilities, and the patients and their caregivers.[23] Communication failures can result in poor patient outcomes.[24] Effective policies and procedures for the delivery of OAT should reduce fragmentation of care by facilitating communication and transitions between healthcare team members with regard to anticoagulation therapy issues. Communication is essential to ensure optimal therapeutic outcomes and should conform to expectations set forth by applicable regulatory agencies (eg, boards of pharmacy, nursing, and medicine). Examples of AMS policies and procedures have been published.[21]

3.2 An efficient system for scheduling and tracking patients should be utilized.

Suboptimal anticoagulant therapy is often attributable to fragmented systems of care.[24] Key components supporting the delivery of OAT can be categorized as: (1) scheduling, (2) testing, (3) decision support, and (4) communication. A tracking system (eg, an electronic database) should be implemented to minimize the possibility that a patient on anticoagulation therapy could be lost to follow-up, even for a brief period.

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