For health care professionals >

Anticoagulation Monitoring Services in Tayside
 

Anticoagulation services in Tayside have undergone significant development since regional planning commenced in 2001. At that time Tayside faced the challenges familiar to many, with increasing numbers of patients requiring anticoagulation and a lack of capacity within primary or secondary care to provide the monitoring service. In addition at that time a variety of service models were in place across Tayside, resulting in an inequitable level of service provision to the patient population. The most common method of service provision at this time was GP practice-sampling, hospital testing, with patients having at least two contacts to get first a blood test and then subsequent result and dosing guidance once laboratory results were available.

In recognition of the clinical evidence available and the above issues, NHS Tayside agreed to fund a near patient testing service for the management of stabilised patients on warfarin in 2003, with a three-year phased roll out of service. Acute management of newly initiated patients continues to be managed within the hospital acute sector, and within primary care by general practitioners through a specific Local Enhanced Service.

Key features of the service include:

• Nurse led, pharmacy supported service.
• Primary care based service, with only patients requiring specialist input attending acute clinics.
• Compulsory theoretical and practical training for all participating staff with local accreditation on completion of training. Ongoing updates and training available at both a local and regional level. 110 staff are now trained and accredited to deliver the service.
• Utilisation of the Hemochron Junior Signature across Tayside, with quality control at local, regional and national level.
• Local development of a web based clinical decision making support system for anticoagulation monitoring in hospital and the community, based on the single electronic patient record, which allows all clinicians involved in the patients care to view INR results and dosing guidance.

The service is now fully rolled out across Tayside as a Local Enhanced Service, delivered either through general practices, locality clinics or domiciliary visits for housebound patients. The service is constantly monitored and developed through a Multi Disciplinary Lead Clinicians Committee at a regional level, with all practitioners reporting through an agreed process, risks/potential risks in the system. The service has been extended to include slow initiation of warfarin for patients with Atrial Fibrillation (AF), following the introduction of AF within the GMS contract in 2006.

Evaluations to date have demonstrated a positive impact upon patient satisfaction with the service they receive, an improved patient understanding of warfarin management and perceived improvement of INR control by patients. Clinical audits have shown significant improvement in the numbers of warfarinised patients with INR's within target ranges, with the service comfortably meeting the British Committee for Standards in Haematology recommended standard.

Contact: Rhona Guild, Primary Care Development Manager, Angus CHP, Forfar.
Email: rhona.guild@nhs.net