Westcliffe community anticoagulation service: a quality: a modernised approach
by Westcliffe Anticoagulation Service
Westcliffe Medical Practice modernised its long-established community-based anticoagulation service in preparation for a forecast increase in number of patients that would require treatment.
The practice took full advantage of the local primary-to-secondary shift schemes and was at the forefront of quality improvements with local commissioners in becoming an accredited provider of community-based anticoagulation services.
The service has gone beyond its original specification of monitoring stable patients. It now initiates patients and offers a range of options from warfarin, NOACs and self-monitoring. It also operates ad hoc screening to identify patients with AF, while to those already known to have AF, it seeks to educate them about anticoagulants.
"This is a clear, well-designed service built in primary care whose objectives suggest patient involvement throughout its development. It has proved to be influential across its entire region and is an exceptional approach to a modern anticoagulation service."
NOAC implementation into primary and secondary care across Southeast Essex
by Southend University Hospital NHS Foundation Trust
The Southeast Essex AF group comprises of commissioners, CCG leads from primary care and champions from stroke, cardiology, clinical pharmacy, haematology and anticoagulation services at Southend Hospital.
Formed in 2010, the group’s achievements include reviewing local arrangements for use of antithrombotic therapies in atrial fibrillation and developing policies for the integration of NOACs into care pathways. It has also provided education explaining how the use of aspirin should be avoided for stroke prevention, as well as on AF and anticoagulation/NOACs.
The group also delivered a NOAC clinic to assess patients with poor time-in-therapeutic range, enabling patients to be actively involved in decisions about their anticoagulant treatment options.
"This work is sustainable and has great patient feedback. The team proved to be ahead of their time by being early adopters of a community-based approach to patients. It manages to pull lots of different strands together and really maximised the levels of support that could be offered to patients."
Guy's and St Thomas' Foundation Trust Ambulatory VTE service
by Guy's & St Thomas' NHS Foundation Trust
Run by the Thrombosis team this service provides a streamlined pathway for managing VTE and ensures patients are seen promptly following diagnosis.
Traditionally, management of acute VTE required admission to hospital often due to the complexities around anticoagulation treatment. Now in the era of the novel oral anticoagulants (NOACs), it is much less problematic.
Patients are provided with information about their condition and given 24/7 contact. As a result of the programme, the team has significantly cut drug costs and bed days for patients with acute VTE.
Patients have found that the service’s ‘one-stop-shop’ approach significantly minimises the number of outpatient appointments and they feel reassured thanks to having a point of contact for any concerns related to their condition.
"This is a commendable service and points to the direction in which we should all be moving. It is a project that clearly brought about positive change to patients and identified efficiency gains in the system, which should make it eminently reproducible."
The Introduction of Direct Oral Anticoagulants (DOACs) to the Southern Trust
by Southern Health and Social Care Trust
The Southern Health and Social Care Trust's anticoagulant team developed guidelines to promote the safe use of DOACs and assist clinicians in initiating medicines.
The team also identified an opportunity to change first-line treatment for patients presenting with a DVT from warfarin and a low molecular weight heparin to a DOAC. The change meant patients would not have to return to the ED for daily injections until their INR was therapeutic.
There was an immediate drop in the number of ED DVT clinic attendances and a fall in the average number of patient visits when the guidelines were introduced.
The team followed this up by measuring the impact of DOAC use on inpatient stay on the acute stroke ward.
"This is an innovative project that demonstrates clear benefit to both patients and the NHS, with the number of people being seen in the emergency department falling significantly. It clearly fulfils the criteria of adding value, giving sustainable benefits, bringing innovation into the NHS and being replicable."