Pharmcovigilance and Risk Minimization of Anticoagulant Use in a General Hospital

Ophir Lavon, Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel (ophir.lavon@clalit.org.il)

Background: Anticoagulants pose significant risk to patients. In hospitals, the risk is higher, as anticoagulant use is common and diverse. There is a need to actively guarantee safety of anticoagulant-treated hospitalized patients.
Methods: A directed program for pharmacovigilance and risk minimization was conceived in 2012 in Carmel Medical Center. Attention was given to all aspects of anticoagulant use by comprehensively mapping medications� variety and practice. Main program principles are limiting access to anticoagulants and performing strict appropriateness review.
Results: Following the program implementation, departments� inventories were reduced and only few anticoagulants were left�warfarin and 2 strengths of enoxaparin. The rest, including heparin and novel oral anticoagulants, were stored in the pharmacy and special units. Dispensing these anticoagulants necessitates the application of designated prescription forms and mandatory pharmacist review. Treatment protocols were prepared to direct anticoagulant proper use. All approved antidotes and countermeasures to control anticoagulant-induced bleeding and laboratory tests for assessment of anticoagulant blood concentrations or activity levels were purchased and now are available in the hospital 24/7. Computerized medical record-derived reports are used to identify prescription errors and misuse and guide pharmacists to perform efficient consultations and interventions. Voluntary reporting of adverse events is intensively promoted; since 2012 to 2018, reporting rates increased 10-fold.
Conclusions: A locally-planned risk minimization program for anticoagulants was successfully implemented. Recorded benefits are the decreased potential for errors and the improved practice of identification of adverse reactions and treatment interventions. Future research should focus on clinical outcomes.

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Abstract Reference & Short Personal Biography of Presenting Author

Head of Patient Safety and Risk Management Unit, and Clinical Pharmacology and Toxicology Unit, Carmel Medical Center, Haifa, Israel.
Clinical lecturer, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Board member, Israel Society for Clinical Pharmacology.
Tresurer and board member, Israel Society of Toxicoloy.
Member of the scientific board and steering committee, ISOP Israel.
Consultant and member of the advisory committee, pharmacy and pharmacovigilance departments, Israel Ministry of Health.