Laura Challen1, Sylvester Agbahiwe2, Tara Cantieri3, Jessica Garcia Olivetti4, Theophilus Mbah5, Yvonne Mendoza-Becerra6, Cesar Munoz7, Michelle Nguyen8, Katashia Partee9, Lincy Lal10, Jocelyn Thomas11, Monica Green12. 1. Assistant Professor of Pharmacy Practice, St. Louis College of Pharmacy , St. Louis, Missouri. 2. Clinical Pharmacist II, Settegast Health Center , Houston, Texas. 3. Clinical Pharmacist II, Strawberry Health Center , Pasadena, Texas. 4. Clinical Pharmacist II, Aldine Health Center , Houston, Texas. 5. Clinical Pharmacist II, Martin Luther King Jr. Health Center , Houston, Texas. 6. Clinical Pharmacist II, Vallbona Health Center , Houston, Texas. 7. Clinical Pharmacist II, E.A. "Squatty" Lyons Health Center , Humble, Texas. 8. Clinical Pharmacist, CommUnityCare , Austin, Texas. 9. Clinical Pharmacist II, El Franco Lee Health Center , Houston, Texas. 10. Clinical Program Manager, Cigna , Missouri City, Texas. 11. Clinical Pharmacist II, Gulfgate Health Center , Houston, Texas. 12. Clinical Pharmacy Manager, Ambulatory Services, Harris Health System, Kirby Administrative Office , Houston, Texas .
Abstract
BACKGROUND: Point-of-care (POC) testing devices allow laboratory monitoring to be performed in various settings and accessed immediately. OBJECTIVE: To evaluate the outcomes of monitoring anticoagulation patients in pharmacistmanaged, multicenter clinics utilizing i-STAT POC machines. METHODS: This study was a retrospective, multicenter chart review of 150 patients before and after implementation of the POC intervention for anticoagulation monitoring. Data collected included international normalized ratio (INR) results, indication for warfarin, minor and major bleeds, thromboembolic events, emergency room (ER) visits, and hospitalizations before and after i-STAT POC implementation. RESULTS: The time in therapeutic INR range (TTR) was significantly higher after i-STAT POC implementation than before implementation (60.4% ± 21.2% and 52.5% ± 21.5%, respectively; P = .0001). There were no reports of major bleeding during the study period. Twenty-three minor bleeds were reported after i-STAT POC implementation compared to 19 events before implementation (P < .0001). One thromboembolic event was reported after i-STAT POC implementation. There was a significant difference in the number of hospitalizations before i-STAT POC implementation as opposed to after implementation (2 and 0, respectively; P < .0001). There was also a significant increase in ER visits after i-STAT POC implementation (P < .0001). CONCLUSION: The results of the study indicate improvement in TTR in pharmacist-managed anticoagulation clinics by 7.8%. Although the use of the i-STAT POC machine detected an increase in minor bleeds, thromboembolic events, and ER visits, there was a decrease in hospitalization. The outcomes of this multicenter study indicate that implementation on this scale provides improvement in regard to safety and cost.
BACKGROUND: Point-of-care (POC) testing devices allow laboratory monitoring to be performed in various settings and accessed immediately. OBJECTIVE: To evaluate the outcomes of monitoring anticoagulation patients in pharmacistmanaged, multicenter clinics utilizing i-STAT POC machines. METHODS: This study was a retrospective, multicenter chart review of 150 patients before and after implementation of the POC intervention for anticoagulation monitoring. Data collected included international normalized ratio (INR) results, indication for warfarin, minor and major bleeds, thromboembolic events, emergency room (ER) visits, and hospitalizations before and after i-STAT POC implementation. RESULTS: The time in therapeutic INR range (TTR) was significantly higher after i-STAT POC implementation than before implementation (60.4% ± 21.2% and 52.5% ± 21.5%, respectively; P = .0001). There were no reports of major bleeding during the study period. Twenty-three minor bleeds were reported after i-STAT POC implementation compared to 19 events before implementation (P < .0001). One thromboembolic event was reported after i-STAT POC implementation. There was a significant difference in the number of hospitalizations before i-STAT POC implementation as opposed to after implementation (2 and 0, respectively; P < .0001). There was also a significant increase in ER visits after i-STAT POC implementation (P < .0001). CONCLUSION: The results of the study indicate improvement in TTR in pharmacist-managed anticoagulation clinics by 7.8%. Although the use of the i-STAT POC machine detected an increase in minor bleeds, thromboembolic events, and ER visits, there was a decrease in hospitalization. The outcomes of this multicenter study indicate that implementation on this scale provides improvement in regard to safety and cost.
Entities:
Keywords:
pharmacist anticoagulation clinic; point of care; warfarin