Although practice varies, patients prescribed DOACs are routinely monitored by specialist anticoagulation services for the first two to three months of therapy, after which their care may be transferred to primary care.

Patients managed by specialised anticoagulation services may have their DOACs dispensed on site. However, delays in appointment systems may result in patients running out of their DOAC before being recalled for an appointment.

Patient safety can also be compromised if the documentation of an anticoagulant switch from warfarin to a DOAC is not received by GPs before they prescribe a repeat supply of warfarin, resulting in duplicated anticoagulation.

Ideally, patients who are instigated on a DOAC in secondary care should be referred to the community pharmacy for an NMS, in accordance with the service specification. However, in reality this is not common practice.

To improve patient safety there is a need for community pharmacy teams to adopt a proactive approach to casefinding patients who have been instigated on a DOAC. When dispensing regular repeat medicines, pharmacy teams should consider how they can capture and record all prescribed medicines, including DOACs, irrespective of where they are dispensed. Members of the pharmacy team could consider asking patients questions such as:

• Have you been seen by any members of the anticoagulation team?
• Have you changed your blood thinning medicines?
• Do you take any medicines that are dispensed in other places, including hospital services?
• Do you take any medicines that are delivered to you at home?
• Do you take any medicines other than the ones that are dispensed by this pharmacy?

Remember, pharmacy teams play an important role supporting patients to stay motivated to take their medicines months and years after being initiated on oral anticoagulant therapy.