Category: Federal Forum Posters
Purpose: At the Fayetteville Veterans Affairs Medical Center, patients prescribed warfarin for the prevention of stroke in atrial fibrillation are managed by a Clinical Pharmacy Specialist (CPS) in the centralized anticoagulation clinic. Patients prescribed a direct oral anticoagulant (DOAC) for the same indication are followed by a CPS within the Patient Aligned Care Team (PACT). The purpose of this quality improvement project is to determine the impact of a screening tool detecting patients who may be appropriate candidates for switching from warfarin to DOAC therapy on anticoagulation clinic metrics, specifically the effects of screening on the number of monthly clinic encounters.
Methods: To determine the impacts of the screening tool on clinic metrics, the number of monthly clinic encounters for three months prior to and after the eight week screening period will be analyzed. To identify patients eligible for DOAC transition screening, the time in therapeutic range (TTR) report was printed weekly for eight weeks from August 2018 – September 2018. Patients prescribed indefinite warfarin therapy for atrial fibrillation who were identified on the report as having a TTR less than sixty percent were further screened at their next scheduled anticoagulation clinic appointment. Patients treated for alternative indications, with any type of heart valve replacement, an international normalized ratio goal other than between two and three, a weight greater than 125 kilograms, or who did not meet Veterans Affairs/Department of Defense (VA/DoD) criteria for medication use were excluded from screening. During the scheduled appointment for warfarin monitoring, identified patients were counseled on DOACs and given the opportunity to switch therapies. Final decision for appropriateness of switching to a DOAC and the determination of the specific DOAC agent to be used was made by the anticoagulation clinic CPS upon review of the patient’s baseline labs and VA/DoD criteria for use.
Results: Not applicable
Conclusion: Not applicable
Jessica Holleman– PGY1 Pharmacy Resident, Fayetteville Veterans Affairs Medical Center, Fuquay Varina, NC