Delivery of Optimized Inpatient Anticoagulation Therapy

Consensus Statement From the Anticoagulation Forum

Edith A Nutescu PharmD FCCP; Ann K Wittkowsky PharmD CACP FASHP FCCP; Allison Burnett PharmD PhC; Geno J Merli MD FACP; Jack E Ansell; David A Garcia MD


The Annals of Pharmacotherapy. 2013;47(5):714-724. 

In This Article

2. Accountability

The inpatient anticoagulation management system should have a clearly defined structure with respect to leadership, accountability, and responsibility, and it should promote multidisciplinary involvement.

Systematic improvements within hospitals should have multidisciplinary involvement, as all disciplines are likely to be affected and teamwork is integral for success. The anticoagulation multidisciplinary group or task force should be composed of frontline medical staff such as physicians, nurses, and pharmacists, along with clinicians from supportive disciplines such as quality and safety, laboratory, dietary, and information technology. Leadership within this group should be clearly delineated, with a dedicated champion (eg, physician leader) to communicate the vision of the group and drive initiatives. Regardless of which discipline (eg, pharmacy, nursing, physician) is the primary driver of the inpatient anticoagulation management system, accountability and responsibility for day-to-day operation of the anticoagulation management system needs to be clearly outlined in hospital policy, procedure, or collaborative practice agreement for operational, clinical, and medical-legal reasons. Frontline staff members providing anticoagulation management need to be aware of resources to draw upon should they encounter clinical situations beyond their level of knowledge, experience, or scope of practice. A hierarchy should be in place that facilitates the delegation of increasingly complex therapeutic situations upward to more knowledgeable, experienced, and/or specialized practitioners. That hierarchy also should delineate a reporting structure and the relationship between the anticoagulation management system and executive level staff. Figure 1 provides one example of how such a hierarchy might be structured. However, no single model will fit all hospitals, as each has unique characteristics, infrastructure, resources, patient demographics, and regulations they must abide by.

Figure 1.

Example of hierarchy of inpatient anticoagulation management system.