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Initiative to improve direct anticoagulant utilization involving programmatic review by clinical pharmacists in collaboration with multidisciplinary team.
The Hadassah Hebrew University Medical Centers' Clinical Pharmacy team initiated a hospital-wide program, in collaboration with the institutions' coagulation specialists, including two hematologists and a clinical pharmacologist, for monitoring and promoting safe and effective prescription of direct oral anticoagulants (DOAC) during hospitalization. Electronic medical records throughout the hospital are screened for DOAC orders. All DOAC orders are assessed by a clinical pharmacist for potentially-inappropriate prescribing. When potentially-inappropriate prescribing or a drug-related problem is identified, the clinical pharmacist provided consultation on management options. In specific cases, additional guidance is provided by coagulation specialists. Consultations are recorded in the electronic medical record. Performance measures are collected and summarized.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinical Pharmacist Medication Review | Other | Programmatic review of physician orders for direct anticoagulants by clinical pharmacists. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of clinical pharmacist consultations accepted by attending physician. | Calculated by dividing the number of clinical pharmacist consultations accepted, by the number of clinical pharmacist consultations given, during the period. Data for consultation counts will be obtained from patient electronic medical record. | At forty-eight months |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of clinical pharmacist consultations accepted by attending physician. | Calculated by dividing the number of clinical pharmacist consultations accepted, by the number of clinical pharmacist consultations given, during the period. Data for consultation counts will be obtained from patient electronic medical record. | At six months |
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Inclusion Criteria:
Patients hospitalized in Hadassah Medical Center with a physician's order for direct oral anticoagulants (apixaban, rivaroxaban, or dabigatran).
Exclusion Criteria:
Patients hospitalized in departments without computerized physician order entry.
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Patients hospitalized in Hadassah Medical Center with a physician's order for direct oral anticoagulants.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Amichai Perlman, Pharmd | Contact | 972505172768 | amichaip@hadassah.org.il |
| Name | Affiliation | Role |
|---|---|---|
| Mordechai Muszkat, MD | Hadassah University Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hadassah Medical Organization, Jerusalem, Israel | Recruiting | Jerusalem | Israel |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30709417 | Derived | Perlman A, Horwitz E, Hirsh-Raccah B, Aldouby-Bier G, Fisher Negev T, Hochberg-Klein S, Kalish Y, Muszkat M. Clinical pharmacist led hospital-wide direct oral anticoagulant stewardship program. Isr J Health Policy Res. 2019 Feb 1;8(1):19. doi: 10.1186/s13584-019-0285-9. |
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