Pharmacy Services at Intermountain Healthcare in Utah operates three anticoagulation specialty clinics. These clinics care for approximately 1,800 anticoagulated patients across Utah and surrounding states. A traditional encounter includes an INR test and face-to-face consultation with a pharmacist or nurse practitioner. Regular INR (international normalized ratio) tests are essential for patients taking warfarin, so postponing all visits indefinitely was not a reasonable option amidst the COVID-19 pandemic.
Furthermore, virtual visits were not possible because an INR test needs to be obtained at every visit. Most anticoagulated patients have multiple comorbid conditions that place them at greater risk for complications from COVID-19. As such, we wanted to minimize their potential COVID-19 exposure from other patients in waiting areas and interactions with staff members.
We initiated a drive-up anticoagulation clinic at each of the three sites. We worked with hospital administration to secure a proper location for the drive-up anticoagulation clinic that would be conspicuous enough for patients to find, but not be confused as a testing site for COVID-19. Mobile workstations were established with computers, phones, and lab testing supplies near the drive-up locations. For two of the locations, alternate office space was identified.
Patients presented to the specified drive-up stall and called the clinic to inform us of their arrival. Screening questions were performed over the phone, including inquiring about new medications, dietary changes, missed warfarin doses, and other factors that can affect the INR. Clinic staff with proper PPE then presented to the patient’s vehicle and performed the INR test. The staff member reported back to the pharmacist, who developed an anticoagulation plan. This plan was relayed back to the patient who was rescheduled at an appropriate interval.
This workflow reduced patient interaction to a single clinic staff member instead of the various staff members and multiple patients commonly encountered in the waiting room and hallways. While there were multiple obstacles to overcome, including managing patients without motor vehicles, managing inclement weather, and guiding patients to the proper location, patient response was overwhelmingly positive. Many appreciated and expressed how grateful they were to minimize their exposure to COVID-19 while also receiving this vital care.
Philip Bassett, PharmD, BCACP, is a clinical pharmacist at Intermountain Healthcare.
Posted April 1, 2021