Title: Procedure Document Version: PROFESSIONAL CHECKING/ORDERING OF ORAL No: Replaced: ANTICOAGULANT THERAPY FOR INPATIENT AREAS, 16 N/A 4 LEAVES AND DISCHARGES (WARFARIN, PHENINDIONE, ACENOCOUMAROL) Procedure Written By: Procedure Approved By: Procedure Reviewed By: Review Next Review Sue Horton, Gurj Bhella Narinder Sangha Date: Date: Senior Pharmacist Chief Pharmacist Deputy Chief Pharmacist 01/03/2018 01/03/2020 STANDARD OPERATING PROCEDURE Objective To ensure safe and consistent working practice throughout the Black Country Partnership NHS Foundation Trust (BCPFT) and to avoid unnecessary harm to patients on anticoagulant therapy, based on NPSA guidance (Patient safety alert ‘Actions that can make anticoagulant therapy safer’). Scope All pharmacists and pharmacy technicians working within BCPFT. Pharmacy technicians (Band 5 or above with training) may order oral anticoagulation in the absence of a pharmacist provided the INR is checked and within range, and the technician seeks further advice if necessary before placing the order. For the purpose of this SOP, oral anticoagulant refers to warfarin, phenindione and acenocoumarol. Procedure 1. If the request for oral anticoagulant therapy is new, the pharmacy technician will complete a Clinical Pharmacy Profile and leave for the pharmacist to authorise. 2. The pharmacist/pharmacy technician must check that the oral anticoagulant therapy has been added to the current Medicines Administration Card. At Penn, an ‘Anticoagulant Therapy’ chart must also be completed fully with patient details, condition for which the anticoagulant is being used and a target INR range. Any relevant details, such as; INR, target INR, frequency of INR monitoring, indication and duration of treatment should also be recorded on the reverse of the Clinical Pharmacy Profile. If relevant details are missing the pharmacist may need to contact the prescriber. 3. Write on the front of the Medicines Administration Card to check if patient has brought their own ‘yellow’ anticoagulant therapy record book in. If not, a new one will be required. This book includes advice for patients and a section for recording of INR results and dosage information and needs to be kept up-to-date. 4. Each patient receiving oral anticoagulant therapy will be provided with their own supply of tablets, in appropriate strengths, to be stored in the trolley/caddy. The pharmacy technician will monitor the level of tablets Version 1.1 March 2018 Page 1 of 3 Title: Procedure Document Version: PROFESSIONAL CHECKING/ORDERING OF ORAL No: Replaced: ANTICOAGULANT THERAPY FOR INPATIENT AREAS, 16 N/A 4 LEAVES AND DISCHARGES (WARFARIN, PHENINDIONE, ACENOCOUMAROL) Procedure Written By: Procedure Approved By: Procedure Reviewed By: Review Next Review Sue Horton, Gurj Bhella Narinder Sangha Date: Date: Senior Pharmacist Chief Pharmacist Deputy Chief Pharmacist 01/03/2018 01/03/2020 STANDARD OPERATING PROCEDURE available in the caddy. When this falls below 14 days supply, he/she will request the pharmacist/pharmacy technician (Band 5 or above) to authorise a further supply. 5. When requested to authorise further supplies of oral anticoagulant tablets, the pharmacist/pharmacy technician (Band 5 or above) must first check that the ‘Anticoagulant Therapy’ chart has been completed and that the patient’s INR has been checked recently and is within the target range. All details must be recorded on the reverse of the patient’s Clinical Pharmacy Profile. If the INR IS within the target range, the pharmacist/pharmacy technician (Band 5 or above) should sign the Clinical Pharmacy Profile to confirm that the dose is suitable for that patient and fax to SLA pharmacy provider for dispensing. If the INR is NOT within the target range, BUT a corresponding, appropriate dose adjustment has occurred and is safe, the pharmacist/pharmacy technician (Band 5 or above) should sign the chart to confirm the supply is suitable for that patient and fax to SLA pharmacy provider department for dispensing. If the INR is NOT within range, and NO dose adjustment has been made, the pharmacist should contact the patient’s medical team to resolve the situation to ensure the patient receives a suitable dose. 6. The pharmacist should endorse the Medicines Administration Card with any clinically significant interactions in current medication regimens and contact the prescriber to discuss any newly prescribed/discontinued medications which would interact with oral anticoagulant therapy. The outcome of any discussions should be recorded on the Medicines Administration Card and reverse of the Clinical Pharmacy Profile. (NB: avoid cranberry juice – anticoagulant effect of warfarin and acenocoumarol possibly enhanced by cranberry juice). 7. Sufficient oral anticoagulant tablets should be ordered to last at least until the next INR is due to ensure that regular monitoring occurs. However, the tablets will continue to be supplied in original packs in most circumstances therefore members of the pharmacy team should remain vigilant and observe a patient’s INR between orders. 8. For leaves/discharges, check that the ‘Anticoagulant Therapy’ chart is up- to date and that the patient’s INR has been checked recently and is within the target range (see 5 for advice re INR). The labelled supply can be taken from the ward if labelled correctly and if a supply greater than Version 1.1 March 2018 Page 2 of 3 Title: Procedure Document Version: PROFESSIONAL CHECKING/ORDERING OF ORAL No: Replaced: ANTICOAGULANT THERAPY FOR INPATIENT AREAS, 16 N/A 4 LEAVES AND DISCHARGES (WARFARIN, PHENINDIONE, ACENOCOUMAROL) Procedure Written By: Procedure Approved By: Procedure Reviewed By: Review Next Review Sue Horton, Gurj Bhella Narinder Sangha Date: Date: Senior Pharmacist Chief Pharmacist Deputy Chief Pharmacist 01/03/2018 01/03/2020 STANDARD OPERATING PROCEDURE duration of leave/discharge has been risk assessed and confirmed by the prescriber. This must be documented on the leave/discharge prescription. Endorse prescription 'from ward' or 'caddy/cupboard'. If a smaller quantity is required, order via SLA pharmacy provider. Write on the leave/discharge prescription that the patient’s up-to-date ‘yellow’ anticoagulant therapy record book needs to be given to the patient. After discharge, any remaining unused tablets should be removed from the ward as soon as possible. 9. Oral anticoagulant tablets should not be placed into medidose/MDS packs under any circumstances. Review and Amendment History - to be completed by Corporate Governance Version Date Description of Change 1.1 Mar 2018 Reviewed and nothing changed 1.0 Sep 2015 New SOP for BCPFT Version 1.1 March 2018 Page 3 of 3 .