Implementation and impact of a multidisciplinary coagulation factor stewardship program at an academic medical center
- PDF / 641,810 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 100 Downloads / 187 Views
LETTER TO THE EDITOR
Implementation and impact of a multidisciplinary coagulation factor stewardship program at an academic medical center Anem Waheed1 · Justin Fongemie2 · Srila Gopal3 · Kimberly S. Esham4 · Leslie Richardson‑Weber5 · Lulu Zhang6 · Layla Van Doren1 · Rachel J. Buchsbaum1 · Raymond L. Comenzo1,5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
To the Editor, The use of coagulation factor products requires specialist expertise, is costly, and can cause adverse outcomes. Close monitoring is required and is complicated because of the involvement of multiple specialties in urgent settings. In particular, coagulation factor products such as 4-factor prothrombin complex concentrates (4F-PCC) and recombinant factor VIIa (rFVIIa) are often used in an off-label manner and require careful consideration [1, 2]. Active stewardship programs may reduce the risk of inappropriate use, increase the likelihood of safe and effective use, and help control costs [3, 4]. Limited evidence exists to support recommendations on the best methods for providing oversight of these products. Our institution is a 415 bed tertiary academic medical center that provides medical services for patients with a variety of acute and chronic conditions, is also a Level 1 trauma center, and is a safety net hospital for the Greater Boston metropolitan area. Notably, our institution has a large surgical population including cardiac surgery patients with mechanical circulatory support devices as well as the highest volume of heart transplantations in New England. The * Anem Waheed [email protected] 1
Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
2
Department of Pharmacy, Tufts Medical Center, Boston, MA, USA
3
Division of Hematology/Oncology, University of California San Diego, San Diego, CA, USA
4
Division of Hematology, University of Washington, Seattle, WA, USA
5
Department of Blood Bank, Tufts Medical Center, Boston, MA, USA
6
St.Peter’s Cancer Center, Albany, NY, USA
objective of this quality improvement initiative was to create a multidisciplinary coagulation factor stewardship program and ascertain its impact on the use of coagulation factors after dispensing them from the inpatient pharmacy instead of the blood bank. Prior to January 2017, approval and dispensation of coagulation products such as 4F-PCC and rFVIIa were managed by the blood bank team. Due to increased off-label use by various teams in the hospital, increased cost of these products, and complexity and delay of dispensation from the blood bank in emergent situations, a multidisciplinary stewardship team was established. This team comprised of pharmacists, hematologists, surgeons, anesthesiologists, and intensivists and transition of these products from the blood bank to the pharmacy was proposed. The guidelines include indications for which 4F-PCC and rFVIIa can be dispensed without hematology consultation and indications for which hematology consultation is required (Fig. 1). At our institution, the
Data Loading...
