Category: Professional Posters
Purpose: Evidence suggests that the majority of medication errors occur during times of care transitions and medication-related adverse events post-discharge are alarming. A standardized transition of care process for hospitalized patients on warfarin is necessary, but it lacks in our facility.
A patient with high thrombosis risk admitted with a thrombotic event who was initiated and discharged on warfarin with improper outpatient follow up triggered the development of this service. The goal of this pharmacy-driven transition of care initiative is to enhance continuity and quality of care for patients newly started on warfarin in a secondary care hospital in Qatar.
Methods: Defined roles and responsibilities were agreed among a team of multidisciplinary members of physicians, pharmacists, and nurses. The service was established in December 2018, first in cardiology, surgery, and internal medicine units for patients initiated on warfarin during the hospital stay. Patients who were discharged with an outpatient follow-up referral in another facility were excluded and were provided with regular standard care. A focused transition of care action plan from hospital admission to post-discharge care included interventions such as distribution of warfarin booklets (pocket educational/ follow up booklet), monitoring of dispensed warfarin quantities, patients education, early completion of discharge summary note, improving timeliness of post discharge follow up, and ensuring proper hands off communication through verbal and written endorsements to the anticoagulation clinic clinical pharmacy specialist.
Clinical pharmacists covering the units conducted several staff education sessions and ensured that team members’ roles were carried as described in the action plan and communicated with them in cases of discrepancies. The initiative was supported by agreement and active involvement of hospital's key decision-makers and frontline staff.
Results: In 6 months, transition of care plans of 21 patients successfully achieved a higher percentage of patients receiving warfarin booklets 76% (16), attending first anti coagulation clinic visit within 3 to 7 days of discharge 86% (18), and achieving therapeutic international normalized ratio (INR) within five days 57% (12). Majority of patients were diagnosed with atrial fibrillation (76%) or deep vein thrombosis (19%).
Conclusion: Proper communication is the key to the success of this service in our facility. We are planning to expand and integrate this model by connecting all of Qatar’s anticoagulation clinics to serve as a national registry for patients on anticoagulants. Clinical pharmacists have unique roles ensuring safe and effective medication therapies and empowering those running transition of care services is of great significance.