Warfarin Management and Counseling
Training and Competency Verification Checklist
I. Services Provided by Pharmacist
All oral anticoagulation should be provided by pharmacy-managed protocol/service. This will include:
 Monitors all patients’ International Normalized Ratio (INR) or other appropriate indicators while on anticoagulation and
adjusts dosing
 Clinical documentation of the critical aspects in the patient medical record for communication among health care
practitioners
 Medication counseling from a pharmacist in the Ambulatory Clinic and, as necessary, prior to discharge for all inpatients
being discharged on warfarin
II. Education and Training Requirements
Educational and Training Elements
Review Policy & Procedure - Pharmacist-Managed Service.
Review: Hirsh J, et al. Oral anticoagulants: mechanism of action,
clinical effectiveness, and optimal therapeutic range. Chest. 2001;
119:8S-21S.
Review: Ansell J, et al. Managing oral anticoagulant therapy. Chest.
2001;119:22S-38S.
Review: Hirsh J, et al. Executive Summary: American College of
Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest.
2008; 133:71-109.
Review: Patient Counseling. In: Murdaugh LB. Competence
Assessment Tools for Health-System Pharmacists, 4th ed. Bethesda,
MD: American Society of Health-System Pharmacists, 2008, p. 40917.
Review anticoagulation patient consultation handout.
Review of USDA National Nutrient Database for Standard Reference,
Release 18 (e.g. vitamin K content of selected foods)
Attend training precepted by qualified pharmacist
Include any other training, education or inservices participated in:
RPh Initials when
Completed/Date
Comments
Pharmacist’s signature:___________________________________ (verifies that all educational and training elements are completed) Date _______
Warfarin Management and Counseling
Training and Competency Verification Checklist
III. Competency Verification
Skill
Passes written test on warfarin
therapy
Identifies appropriate indications for
oral anticoagulation.
Transitions patient from IV heparin
to oral anticoagulant.
Develops patient-specific
anticoagulation plan (ambulatory
setting)
Discusses drug-drug, drug-nutrient,
and drug-disease interactions
involving warfarin.
Counsels patients receiving warfarin
and assesses counseling effectiveness
with the patient.
Follows protocol for managing
warfarin.
1.
2.
3.
4.
5.
6.
7.
Methodology*
Competent
/Date
Not
Competent
/Date
Comments/
Corrective Action
*Competency Verification Methodology: C = case study response; O = observation in the real setting; M = mock event, demonstration; P = paper and
pencil test; R = record review; E = exercises (written); V = verbal response/discussion
IV.
Yes
V.
Training and Competencies Verified
No
N/A
Comments
Competency Assessed by:
Pharmacy Director
Signature: ____________________________________
Date: __________