Abstract
To improve the safety of anticoagulation initiation by increasing the proportion of patients reviewed by a pharmacist. An electronic intervention was developed to ensure all patients prescribed anticoagulation on discharge were reviewed by an ED pharmacist. Safe anticoagulation initiation was compared for patients seen and not seen. The intervention increased the number of patients seen by an ED pharmacist. Pre-intervention (n=238) 84.5% of patients were reviewed by a pharmacist. Post-intervention (n=253) 99.6% of patients were reviewed by a pharmacist. Of the 38 patients not reviewed by a pharmacist, 20 (52.6%) had safe anticoagulation initiation and in a sample of 40 patients reviewed by a pharmacist, all 40 (100%) had safe anticoagulation initiation (52.6% vs 100%, P < 0.001). The real-time electronic intervention improved the number of patients reviewed by a pharmacist. ED pharmacist reviewed patients were more likely to have safe anticoagulation initiation.
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