Pharmacist Prescribing in Warfarin Therapy: Exploring Clinical Utility in the Hospital Setting

Background Managing warfarin therapy can be challenging and a multidisciplinary approach to achieve optimal outcomes can be beneficial. Internationally, extended roles for pharmacists have involved collaborative prescribing privileges. Aim To explore the clinical utility and capacity of pharmacists to undertake prescribing functions in anticoagulation management in the hospital setting. Methods Pharmacists were recruited from a large Sydney teaching hospital. A questionnaire was used to simulate a pharmacist prescribing function and to explore their opinion of the usefulness of prescribing and their confidence to undertake such roles. The appropriateness of pharmacists' prescribing decisions was evaluated. Results Prescribing authority was generally considered useful for pharmacists in the management of warfarin therapy. Pharmacist prescribing in the inpatient setting was thought to enable enhanced pharmacovigilance and be useful when medical staff are unavailable. However, outpatient settings were considered more appropriate. Dependent or collaborative models of prescribing were considered more appropriate than independent models. Despite expressing confidence in their ability to prescribe, the majority of participants' responses (58%) were deemed clinically inappropriate. Lack of training and experience and opposition from the medical team were identified as potential barriers toward pharmacist prescribing. Conclusion Extended prescribing roles for pharmacists in anticoagulation management may be useful, particularly in the outpatient setting. Training and experience is needed to ensure safe prescribing practices are maintained.