Impact of a Pharmacist-Driven Prothrombin Complex Concentrate Protocol on Time to Administration in Patients With Warfarin-Associated Intracranial Hemorrhage

Jessica L. Corio, PharmD; Jonathan H. Sin, PharmD; Bryan D. Hayes, PharmD; Joshua N. Goldstein, MD, PhD; Lanting Fuh, PharmD


Western J Emerg Med. 2018;19(5):849-854. 

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There are several limitations to address within the design of this study. First, this was a single-center, retrospective chart review. Second, patients were only included if 4F-PCC was requested during clinical ED pharmacist coverage hours (7:30 a.m. to midnight daily). As workflow processes differ overnight, we were unable to assess the impact on time to administration during this time period. Third, as this was a retrospective study, there may have been differences between the time of administration documented in the chart and the true time of administration. While neuroimaging results may have been discussed verbally prior to documenting the final read in the EMR, time stamps from the EMR were used to eliminate variation between cases. Fourth, as this was an observational study, it is possible the change in 4F-PCC administration time was due to an unmeasured confounder rather than the change in workflow. However, we are unaware of any other clinical process surrounding 4F-PCC administration that changed during this time frame. Fifth, given the small sample size, we were underpowered to evaluate any effect on clinical outcomes.