Impact of i-STAT point of care implementation in a pharmacist-managed anticoagulation clinic: A retrospective analysis

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Hospital Pharmacy


Purpose: To evaluate the impact that close monitoring by a clinical pharmacist using the i-STAT point of care (POC) machine had on outcomes of anticoagulation patients.Methods: This study was a retrospective chart review of 40 patients with an average age of 58.7 who served as their own historical control. Data collected included international normalized ratio (INR) results, indication for warfarin, adverse drug events, emergency room visits, and hospitalizations both before and after the i-STAT POC implementation (November 2006 to August 2009).Results: The proportion of time within therapeutic INR range 2.0 to 3.0 was higher after i-STAT POC implementation compared to before (46.3% and 56.2%; P =.001). When a wider INR range was analyzed (1.8-3.2), the proportion of time within range was 64.6% versus 68.9% (P =.001). In terms of safety, 27 adverse events were documented before and 22 adverse events were documented after i-STAT implementation. Eighteen hospitalizations were related to bleeding or clotting and were distributed evenly between before and after i-STAT implementation. Percentages of medication nonadherence were 12.5% before and 12.1% after the implementation.Conclusion: The results of this study indicate that implementation of the i-STAT POC machine in a pharmacist-managed anticoagulation clinic increased percent of time within therapeutic INR by 9.9%. Patient INR results were better controlled at more stable levels. Furthermore, use of i-STAT POC showed improvement in terms of safety, adherence, and cost. Though the significance of these results requires further study, the promising positive outcomes will certainly encourage implementation of this model on a larger scale. © 2011 Thomas Land Publishers, Inc.

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