Anticoagulation Clinic - Pharmacist Procedures
1.
Receiving a “Patient Referral” form from the physician’s office initiates the
patient’s enrollment into the Anticoagulation Clinic.
2.
Review form to make sure all pertinent information is completed properly.

If New Coumadin Patient :
Fill prescription for Coumadin  at MVP

Counsel Patient  Provide Patient
with “A Patient’s Guide To Using Coumadin ” and Daily Pill Box

Schedule
Initial Visit/Appt with Anticoagulation Clinic & Initial Lab Test (1 week out)

If Established Coumadin Patient :
Review “Referral Form”

Contact Patient  Schedule Initial Visit/Appt with
Anticoagulation Clinic & patient’s next Lab Test (see protocol)
New and Established Coumadin patients must then be entered into the
Anticoagulation Database in the Anticoagulation Patient Table. All data fields
must be populated. Database been created using the program “Access” and is
located on the back computer in the hospital pharmacy. Sample listed below.
3.
Anticoagulation Patient Table
Referring
Physician
Patient First
Name
Patient Last
Name
Designated INR
Range
Last
INR
Date Last
INR
Notes
Alin
Backus
Basta
Geurts
Linder
McDevitt
Mulhern
Outside MD
Parmelee
Shafer
Zaveruha
Carlos Otis Health Care Center
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Anticoagulation Clinic
4.
New and Established Coumadin patients with scheduled appointments
must then be entered into the Anticoagulation Database in the
Anticoagulation Patient Appointment Schedule Table. All data fields must be
populated. Database been created using the program “Access” and is located
on the back computer in the hospital pharmacy. Sample listed below.
Anticoagulation Patient Appointment Schedule Table
Referring
Physician
Alin
Backus
Linder
Geurts
Shafer
Patient First
Name
Suzanne
Greg
Monica
Sara
Jim
Patient Last
Name
Light
Dean
Lightfoot
Niklas
Heal
Appointment
Date
12/13/2003
01/14/2004
12/31/2003
12/31/2003
01/14/2004
Appointment
Time
0800
0900
1130
1300
1430
Notes
New Patient
Adjustment Made-F/U Lab
Adjustment Made-F/U Lab
Established/Stable Pt
New Patient
5.
Fill out Lab Sheet for patient’s INR and send it to Patient Admissions.
(Sue Tweedy has file for Anticoagulation Clinic patient INR’s)
6.
A Daily Patient Appointment List should be run EVERY morning by a
pharmacist for that day in order to see what patient’s are scheduled for labs
and consultation. The report should then be sorted by “Appointment Time”
and printed in landscape format. The appointment list can be found in the
Anticoagulation Database. Sample(s) of the Daily Patient List is shown below.
Anticoagulation Clinic Daily Appointments
Appointment
Date
12/31/2003
12/31/2003
Appointment
Time
1130
1300
Patient First
Name
Monica
Sara
Patient Last
Name
Lightfoot
Niklas
Notes
Adjustment Made-F/U Lab
Established/Stable Pt
Anticoagulation Clinic Daily Appointments
Appointment
Date
01/14/2004
01/14/2004
7.
Appointment
Time
0900
1430
Patient First
Name
Greg
Jim
Patient Last
Name
Dean
Heal
Notes
Adjustment Made-F/U Lab
New Patient
Contact physician’s office to obtain patient’s chart before patient’s initial visit to
the Anticoagulation Clinic.
Carlos Otis Health Care Center
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Anticoagulation Clinic
8.
Review chart and patient’s medical history. Begin filling out COHCC Warfarin
(Coumadin) Service : History & Checklist before patient’s initial visit to the
Anticoagulation Clinic.
9.
During appointment with patient take a complete drug history from patient and
complete the COHCC Warfarin (Coumadin) Service : History & Checklist.
10.
Teach the patient the how to recognize signs/evidence of bleeding, and when to
report these to the pharmacist and/or physician.
11.
Instruct the patient to take his/her Coumadin at the same time every day.
12.
Advise the patient to wear a medic-alert bracelet with the name of the drug on it
or the patient should carry a wallet card with his or her name, name of the
drug, and the name of the physician/pharmacist who is providing the care for
the use in emergency situations.
13.
Advise the patient not to take or discontinue any medications without the
direction of their physician/pharmacist.
Warn the patient to avoid
over-the-counter products that contain aspirin, other salicylates, alcohol,
acetaminophen, or drugs that interact with Coumadin .
14.
Teach the patient that eating inconsistent amounts of foods containing
Vitamin K may alter their anticoagulant effects. Stress the importance of
consistency.
15.
Instruct the patient to about the possibility of bruising.
Also, advise the
patient about using an electric razor and a soft bristle toothbrush to eliminate
potential hazards and excessive bleeding due to cuts.
16.
Advise the patient to avoid alcohol or at least keep ingestion consistent.
17.
Review and discuss INR results with patient, making appropriate adjustments if
necessary per protocol.

If Adjustment Required :
Refer to Weekly Dosing Equivalents Form 
Make Adjustment to Patient’s Dosing
Regimen  Fill out Adjustment Notification form

Send Notification to Medical
Director/PCP
18.
Schedule patients next visit to the Anticoagulation Clinic and Lab Test
according to protocol.
Carlos Otis Health Care Center
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Anticoagulation Clinic
19.
Fill out Lab Sheet for patient’s next INR and send it to Patient Admissions.
(Sue Tweedy has file for Anticoagulation Clinic patient INR’s)
20.
Fill out the Anticoagulation Monitoring Flow Sheet and place the form in the
designated area of the patient’s chart.
21.
Update the Anticoagulation Patient Table in the Anticoagulation Database after
each clinic visit. Sample listed below.
Anticoagulation Patient Table
Referring
Physician
Backus
Basta
22.
Patient First
Name
Greg
Sara
Patient Last
Name
Dean
Niklas
Designated INR
Range
2.0 – 3.0
2.5 – 3.5
Last
INR
3.8
2.8
Date Last
INR
01/01/2004
11/14/2003
Update the Anticoagulation Patient Appointment Schedule Table
Anticoagulation Database after each clinic visit. Sample listed below.
Notes
On Abx
Stable
in the
Anticoagulation Patient Appointment Schedule Table
Referring
Physician
Alin
Patient First
Name
Suzanne
Patient Last
Name
Light
Appointment
Date
12/20/2003
Appointment
Time
0800
Notes
1st Lab - Follow Up
Note :
Elderly patients and patients with renal and hepatic failure are especially sensitive to Coumadin  effects
and should be monitored very closely.
Questions, Comments &/o Additions :
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Carlos Otis Health Care Center
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