Table 2Between-hospital variations affecting generalizability

HospitalPrior inpatient pharmacist involvement with warfarin-related carePrior pharmacist-physician clinical interactionsWorkflow and logistical factors affecting implementation
AExtensiveWell-establishedDisruption minimized by assigning WARFDOCS duties to the “warfarin pharmacist” of the day
BMinimalMinimal in the inpatient setting (a pharmacy-run warfarin clinic handles about 50% of outpatients)Pharmacists “assigned to station” and cannot leave without coverage
CModerate; pharmacists review INRs and potential drug interactionsMinimalPharmacists work 3–4 shifts per week, necessitating frequent handoffs of WARFDOCS responsibilities
DModerate; hospital computer system allows pharmacist to follow warfarin doses and subsequent INRsMinimalSubstantial physical distance between pharmacy computer (source of dosing information) and nursing station (source of laboratory data)
EModerate; extensive in six months prior to launch of WARFDOCSModerate; warfarin declared a “quality improvement focus” by parent hospital chain in 2003, leading to “warfarin per pharmacy” in about half of patientsPDAs already in wide use (e.g., for assessing drug interactions), but this created own problems; pharmacists complained about multiple PDAs

From: From Insight to Implementation: Lessons from a Multi-site Trial of a PDA-based Warfarin Dose Calculator

Cover of Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues)
Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues).
Henriksen K, Battles JB, Marks ES, et al., editors.

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