ACCP MODEL PRACTICE

(UCDMC) have been interested in optimizing the management of thromboembolic diseases since the early 1980s.1,2 One of the earliest improvements in managing patients requiring anticoagulation was the establishment of an outpatient anticoagulation clinic in 1985 to monitor warfarin therapy. A pharmacist was added to the staff in 1993. In 1992, clinicians managing inpatients became increasingly concerned about measured dose responses when using warfarin or unfractionated heparin (UFH) and about occurrences of bleeding or thrombotic complications. At the request of the medical staff, the pharmacy department began to assist in the day-to-day management of inpatients requiring anticoagulation therapy. Description A formal pharmacist-managed anticoagulation service was one of two programs developed in 1991 as an expansion of pharmacy services to address drug use concerns identified by the institution’s Pharmacy and Therapeutics (P & T) Committee. The other program was a formal Clinical Pharmacy Consult Service to review requests for medication therapies that were identified as high risk or high cost; all such reviews were to be done before any drugs were dispensed. A small group of pharmacists, which included the anticoagulation specialist, was identified to fulfill these tasks, enabling cross-coverage between services for continuity of care. The initial charge for the pharmacist assigned to the anticoagulation service was to explore ways of improving patient care and approaches to resolving issues in the management of thrombosis. At this time, the two primary anticoagulants in use were UFH and warfarin