Table 1.

Systematic approaches for safe and effective inpatient anticoagulation management

System	Possible action(s)
Storage	Separation of anticoagulants in the pharmacy and in medication dispensing cabinets Distinct labeling to identify anticoagulants as high-risk medications
Ordering	Electronic alerts in pharmacy order entry system for required laboratory tests (weight, SCr, INR, etc.) pertinent to anticoagulation therapy Use of approved, standardized pre-printed or electronic order sets for all anticoagulants to promote uniformity and decrease errors related to illegible handwriting Utilization of computerized physician order entry
Preparation	Minimize number of stock concentrations of anticoagulants
Distribution	Dispense anticoagulants in oral unit dose, pre-filled syringes or pre-mixed infusions when possible
Administration	Independent double check by nursing prior to administration Use of programmable infusion pumps Bedside barcode scanning
Therapeutic Management	Utilization of dedicated anticoagulation programs and services that facilitate coordinated care management. Involvement of pharmacists as drug experts, in the care of patients on high-risk medications, such as anticoagulants