Justification of a clinical pharmacist position for inpatient anticoagulation

Purpose: Anticoagulation is associated with a high risk for serious adverse drug events. The Joint Commission and other national healthcare quality related organizations recommend close pharmacy oversight and involvement with anticoagulation and implementation of a pharmacist managed anticoagulation service. Our goal was to provide justification for a clinical pharmacist FTE in the area of anticoagulation in order to reduce the risk for serious adverse drug events.

Methods: The ROI required hiring a clinical pharmacist as a “temporary” position within the pharmacy budget, and quantifying their interventions to reduce risk factors for nephrotoxicity. The costs of adverse drug events were estimates based on current literature.

Results: During the 90 day trial, the pharmacist made 145 interventions and prevented 30 serious adverse drug events. Most of the events were related to warfarin dosing and monitoring. Cost savings related to reduce adverse drug events were estimated at $50,751 in the first 90 days and the cost of the position was $35,863 during the same period yielding an estimated ROI of $59,553 annually. This data was shared with hospital administration and a permanent FTE was approved.

Conclusions: We proposed an FTE for a clinical pharmacist to assist with the management of inpatient anticoagulation in order to reduce risk for adverse events. Our ROI analysis justified this position.