Nurse led VTE service and anticoagulation outreach service
by Salisbury NHS Foundation Trust
These two services cover all aspects of a patient’s anticoagulation journey.
The VTE service sees patients assessed in a nurse-led clinic, after which treatment is initiated or care escalated to medics if required. Its single-centre approach has delivered several key healthcare improvements. These include a significant reduction in hospital admissions for DVT and the efficient and safe introduction of novel oral anticoagulants (NOAC) into VTE pathways.
The outreach anticoagulation service operates Monday to Friday on wards to assess all patients receiving anticoagulation treatment on VKA or a NOAC. Since its introduction in September 2014 there has been a clear reduction in anticoagulation medication incidents.
"As judges, we liked the approach to using nursing in this role and were impressed by the streamlined integrated care pathway and collaboration with other departments. There is a good baseline assessment of care and involvement of service users along the way. National guidelines are met and patient care, experience & satisfaction improved, in a cost-effective service."
Health call INR monitoring project
by County Durham and Darlington NHS Foundation Trust
County Durham and Darlington NHS Foundation Trust, Roche and Inhealthcare created and piloted a self-testing service for warfarin patients.
Patients used a self-testing device to test their International Normalised Ratio (INR) levels and sent their results to the warfarin clinic through Inhealthcare’s automated platform.
The project reduced the time patients spent in the warfarin clinic and demonstrated significant lifestyle improvements. There was also an increase in the time patients were within their therapeutic range.
The service is replicable and financially sustainable and, based on this, the Trust subsequently established a Health Call Monitoring service, in conjunction with Inhealthcare, as a permanent patient service.
"We felt that this programme showed an innovative approach and patient self-testing is a great enabler to better self-management. The huge improvement in TTR is very impressive and it is great to see industry working with NHS to enhance the patient experience."
Transforming DVT patient care pathway across primary and secondary care
by SEQOL Specialist Treatment Centre
A not-for-profit organisation, SEQOL works with the NHS in and around Swindon. The DVT service is nurse-led and sees around 1,700 patients a year. It is staffed within a community specialist treatment centre and out-of-hours cover is provided by a SEQOL urgent care centre.
Patients are seen initially within the treatment centre, urgent care centre or within their own homes and are managed until a diagnosis of DVT is confirmed or excluded.
Patients with a confirmed DVT are reviewed by the Acute Trust’s anticoagulation team for continued treatment and return to the urgent care centre 1-2 weeks after diagnosis. At this point patients may also be signposted to external agencies for support.
"This is an impressive pathway – start, middle and finish all combines with the patient story. There are clear and excellent benefits for patients which have been well evaluated and documented."