At our site, the nurse practitioners mostly monitor the weekly INRs and manage warfarin. The pharmacists are involved with following INR/warfarin by referral mostly for patients with difficult to manage INR and low time in therapeutic range. The pharmacist is then involved in assessing factors that could be contributing to the out of range INR (i.e drug interactions, adherence) and also with helping develop strategies to improve TTR (i.e. written dosing information, warfarin calendars).
A new initiative we are also now involved with is quarterly warfarin report cards for patients on warfarin. These reports highlight the TTR for the past quarter and include indication for warfarin therapy as well as previous TTRs. These are shared with the team on a quarterly basis and it allows for targeting patient’s with low TTRs as well as reassessing the choice of warfarin therapy in some cases.