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Time to four‐factor prothrombin complex concentrate administration decreased by presence of a 24/7 pharmacist in the emergency department
Author(s) -
Kozlow Erin A.,
Livings Sarah E.
Publication year - 2021
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1350
Subject(s) - medicine , emergency department , prothrombin complex concentrate , atrial fibrillation , warfarin , pharmacist , anesthesia , prothrombin time , confidence interval , pharmacy , psychiatry , family medicine
Abstract Study objective The objective of this study was to determine the impact of a 24/7 pharmacist (RPh) on time from order to the administration of four‐factor prothrombin concentrate complex (4F‐PCC) in the emergency department (ED). Methods This is a retrospective study that included patients who received 4F‐PCC in the ED for acute reversal of oral anticoagulation before and after the implementation of a 24/7 RPh. Patients for whom 4F‐PCC was ordered between May 1, 2014 and June 30, 2015 were in the pre‐RPh group and those between November 1, 2018 and December 31, 2019 were in the post‐RPh group. The primary end point was time from order to administration of 4F‐PCC. Time from arrival to administration of 4F‐PCC was also evaluated. Results Of 168 patients evaluated, 100 were included in the study (n = 33 pre‐RPh; n = 67 post‐RPh). The majority of patients were on warfarin (97.0% pre‐RPh and 73.1% post‐RPh) for atrial fibrillation. Both groups included trauma and intracranial hemorrhage patients. The mean time from order to 4F‐PCC administration was significantly shorter in the post‐RPh group (71.2 vs 35.2 minutes, P < .001, 95% confidence interval [CI] [27.013‐44.987]). In addition, the median time from arrival to 4F‐PCC administration was also shorter in the post‐RPh group (153 vs 106 minutes, P = .033). Conclusions At our institution, time from order, and from arrival, to administration of 4F‐PCC for reversal of oral anticoagulation in the setting of acute bleeding events in the ED was reduced by 36 minutes after the presence of a 24/7 pharmacist.