Anticoagulation Interventions by Pharmacists in Acute Care
Bibliographic record
Abstract
Background: Clinical pharmacy key performance indicators (cpKPIs) relate to activities performed by pharmacists that have been shown to improve patient outcomes. Within Saskatchewan Health Authority (SHA) Regina, most cpKPIs are incorporated into the organization’s clinical practice standards, which provide guidance in prioritizing care, especially for high-risk medications, including anticoagulants. To track pharmacists’ interventions associated with clinical practice standards, a locally developed electronic data-capture system (known as AIM High) was implemented. Objectives: To quantify and describe pharmacists’ anticoagulation interventions on 16 wards with dedicated ward-based clinical pharmacists and to compare intervention rates between the cardiology and internal medicine wards to further evolve the organization’s practice model. Methods: Data from the electronic data-capture system were retrospectively analyzed for a 5-year period (January 2016 to December 2020). Results: A total of 94 201 interventions were recorded in the AIM High system (average 362 interventions per week or 26 interventions per pharmacist per week). Of these, 15 661 (16.6%) cited the anticoagulation standard (average 60 anticoagulation interventions per week or 4 anticoagulant interventions per pharmacist per week). For the cardiology and internal medicine wards, 4183 of 11 888 (35.2%) and 9034 of 54 843 (16.5%) interventions cited the anticoagulation standard, respectively. The top 4 types of anticoagulation interventions were dose changed (n = 4372 or 27.9%), drug started or restarted (n = 3867 or 24.7%), patient education (n = 3094 or 19.8%), and drug discontinued (n = 2944 or 18.8%). Conclusion: Dedicated ward-based clinical pharmacists were following clinical practice standards incorporating the majority of cpKPIs to complete anticoagulation interventions. The types of anticoagulation interventions evolved over time and were influenced by the patient population. RÉSUMÉ Contexte : Les indicateurs clés de performance en pharmacie clinique (ICPEPC) se rapportent à des activités exécutées par des pharmaciens qui ont fait leurs preuves dans l’amélioration des résultats pour les patients. À la Saskatchewan Health Authority (SHA) Regina, la plupart des ICPEPC sont intégrés aux normes de pratique clinique de l’organisme. Celles-ci fournissent des conseils pour hiérarchiser les soins liés aux médicaments, en particulier ceux associés aux médicaments à haut risque, notamment les anticoagulants. Un système électronique de saisie de données développé localement, le « AIM High », a été mis en place afin de suivre les interventions des pharmaciens associées aux normes de pratique clinique. Objectifs : Quantifier et décrire les interventions des pharmaciens en matière d’anticoagulation dans 16 services avec des pharmaciens cliniciens dédiés et comparer les taux d’intervention entre les services de cardiologie et de médecine interne en vue de faire évoluer davantage le modèle de pratique de l’organisation. Méthodes : Les données du système électronique de saisie des données ont été analysées rétrospectivement sur une période de 5 ans (de janvier 2016 à décembre 2020). Résultats : Au total, 94 201 interventions ont été enregistrées dans le système (moyenne de 362 interventions par semaine ou 26 interventions par pharmacien par semaine). Parmi celles-ci, 15 661 (16,6 %) citent la norme d’anticoagulation (moyenne de 60 interventions d’anticoagulation par semaine – soit 4 interventions d’anticoagulation par pharmacien par semaine). Pour les services de cardiologie et de médecine interne, 4183 (35,2%) des 11 888 et 9034 (16,5 %) des 54 843 interventions citent respectivement la norme d’anticoagulation. Les 4 principaux types d’interventions d’anticoagulation étaient le changement de dose (n = 4372 ou 27,9 %), le traitement commencé ou redémarré (n = 3867 ou 24,7 %), l’éducation du patient (n = 3094 ou 19,8 %) et l’arrêt du médicament (n = 2944 ou 18,8 %). Conclusion : Les pharmaciens cliniques dédiés au service suivaient les normes de pratique clinique incorporant la majorité des ICPEPC pour mener à bien les interventions d’anticoagulation. Les types d’interventions d’anticoagulation ont évolué au fil du temps et ont été influencés par la population de patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.047 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".