Impact of pharmacist intervention on anticoagulation management and risk for potential COVID-19 exposure during the COVID-19 pandemic.

INTRODUCTION: Patients taking warfarin require frequent international normalized ratio (INR) monitoring in healthcare settings, putting them at increased risk of Coronavirus disease 2019 (COVID-19) exposure during the pandemic. Thus, strategies to limit in-person visits to healthcare facilities were recommended by the Anticoagulation Forum. The objective of this study was to describe the number and types of changes made to anticoagulation therapy as a result of pharmacist intervention during the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective chart review of patients included in a primary care COVID-19 anticoagulation intervention was conducted. During this intervention, pharmacists provided individualized recommendations for anticoagulation changes in patients taking warfarin to limit their healthcare facility exposure while also maintaining safe anticoagulation management practices. RESULTS: As a result of pharmacist intervention, 83 (55.7 %) of the 149 patients included in the intervention had changes in anticoagulation including: switching to a direct oral anticoagulant (n = 12), extending the INR monitoring interval (n = 48), switching to home INR monitoring (n = 21), or stopping anticoagulation (n = 2). For those patients who were taking warfarin for the entire 6 months pre- and post-intervention, the total number of healthcare facility and laboratory visits with an INR completed decreased from 8.8 to 6.4 (p < 0.001) per patient without a statistically significant decrease in time in therapeutic range (p = 0.76). CONCLUSIONS: This study depicts rapid implementation of a population health-based approach to assess all patients taking warfarin for options to minimize healthcare visits and decrease risk for COVID-19 exposure. Methods to reduce healthcare visit burden while maintaining patient safety should be considered as a regular component of anticoagulation management post-pandemic.

Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students.

BACKGROUND AND PURPOSE: To assess impact of a pharmacist-led educational intervention on family nurse practitioner (FNP) students' prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator. METHOD: Prospective pre-post assessment of a 14-week educational intervention in an FNP program in the spring semester of 2014. Students participated in an online module of weekly patient cases and prescriptions emphasizing legal requirements, prescription accuracy, and appropriate therapy. A pharmacist facilitator provided formative feedback on students' submissions. Participants completed a matched assessment on prescription writing before and after the module, and a retrospective postsurvey then presurvey to collect perceptions. CONCLUSION: There was significant improvement in performance on error identification and demonstration of prescription elements from preassessment to postassessment (+17%, p < .001). The mean performance on both assessments was less than the 70% passing score. Students reported significant positive changes in perceptions, including all statements regarding their preparedness to prescribe and those addressing willingness to collaborate with pharmacists. IMPLICATIONS FOR PRACTICE: Formative education on prescribing enhanced students' understanding of safe and effective medication use with improved recognition and avoidance of prescribing errors, although it did not result in competency. Exposure to pharmacist expertise in this area may encourage collaboration in practice.