Development of a Direct Oral Anticoagulant Monitoring Service in a Family Medicine Clinic Caprisse Honsbruch, Leah Mouw, Zachary Mulford, Jay Tieri, Sara Wiedenfeld PharmD Background Siouxland Medical Education Foundation is a family medicine residency program in Sioux City, IA. They provide family medicine care to over 40,000 patient visits annually. One of the main services provided by pharmacists at the clinic is anticoagulation management. Currently, patients being placed on direct oral anticoagulation (DOAC) therapy are not being monitored due to a lack of monitoring guidelines for these newer high-risk medications. DOAC use is relatively new to anticoagulation therapy. Education is needed for both the patient and provider regarding the use of DOACs. Background Figure 1: Depicts the handout that is given to each new patient started on DOAC therapy. Using patient friendly language it explains what a DOAC is, why they are taking it, and addresses other important information they should know about their new medication. Figure 2: Monitoring flow chart that is used in practice by providers initially to guide DOAC selection taking into account patient specific demographics. It is used by pharmacy students subsequently for follow-up phone calls with patients to assess proper medication therapy. Results Results Interventions Patient Demographics Figure 3 Goal To develop a comprehensive evidence-based monitoring service that can be implemented by pharmacy students in the clinic to increase the safety and efficacy of these high risk medications. 73 patients were included at the beginning of the study, but 6 patients discontinued their DOAC once the monitoring program was initiated and their data was not analyzed. There were 112 student-led interventions (figure 3). Out of the 22 patients called for follow-up 2 reported bruising, 1 reported non-significant bleeding, and 1 reported financial concerns. Methods Methods This observational analysis project was an example of a quality improvement initiative. Searched PubMed and analyzed what monitoring guidelines were already in use, and contacted UIHC about monitoring programs already in place. A monitoring flow chart and patient handout was developed. Inclusion criteria included all patients identified on a DOAC using an electronic medical record. Conclusion Follow-up and monitoring are important in patients taking DOACs. Pharmacy students can be utilized to provide safe and effective monitoring to patients on DOACs in clinics which provide pharmacist-led anticoagulation management to improve patient care. Conclusion Figure 1 Figure 2