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 (NOACs) into VTE pathways. The outreach anticoagulation service operates Monday to Friday on wards to assess all patients receiving anticoagulation. Patients on VKA are assessed and dosed and their bridging managed. NOAC patients are assessed and then counselling is provided. PE patients are seen and early discharge facilitated. For all groups, on-going care is organised and there has been a clear reduction in anticoagulation medication incidences since the implementation in September 2014.
Historically patients with VTE (DVT & PE) were all managed via standard emergency approaches including medical admission. While this was regarded as being a 'safe' approach there were a number of disadvantages – not least that the majority of patients were seen as medical emergencies will be admitted to hospital and the opportunities for an integrated single-stop specialist care pathway may be more limited if VTE patients are managed in a mixed emergency environment. Patients were unhappy with the current process due to the amount of time it was taking to be seen and discharged home. Meanwhile, patients were being dosed by the anticoagulation nurses remotely, their INRs were sent to the lab for processing and then the anticoagulation dosing card completed. Ward doctors and nurses were asked to complete the chart with concomitant medication and any changes: this was time consuming for the anticoagulation nurses it was also frustrating for the ward nurses to be interrupted from patient care – and invariably the information was not completely accurate, making dosing potentially unsafe. Clinical incidences in anticoagulation were continually being flagged as a concern and general education of staff was clearly not having the desired impact.
For the two services:
- To create an integrated pathway for VTE patients in an ambulatory setting which would reduce hospital admissions, increase patient and healthcare professional satisfaction with the service and streamline VTE management.
- To have an anticoagulation nurse specialist attending all inpatient wards on a weekday daily basis, improving patient care and satisfaction, reducing clinical incidences, assessing stable PE patients to facilitate a rapid discharge and providing counselling.
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