Finalists & Winners2018
In it's second year, the award ceremony for the prestigious Anticoagulation Achievement Awards was hosted by Lyn Brown MP and Chair of the All Party Group for Thrombosis, in the Terrace Pavilion, House of Commons on Wednesday 10 October 2018
The Awards were presented by an eminent panel of representatives from the House of Commons, leading healthcare leaders and the World Thrombosis Day Committee.
The awards celebrated outstanding practice in the management, education and provision of anticoagulation across the UK.
Best Resource Sharing Information about Anticoagulation Therapy for Patients and Careers
Guy's and St Thomas' NHS Foundation Trust
Direct acting oral anticoagulants (DOACs) are an effective alternative to warfarin for reducing the risk of stroke in patients with atrial fibrillation. Patient adherence to medicine is positively correlated with their satisfaction with the information they receive. Patients often have specific questions about medicines, broadly classified into "actions and uses" (practical issues) or “necessity and concerns” (their beliefs about their illness and medicines). Patients' information needs may change over time.
A satisfaction project completed at Guy's and St Thomas' following the introduction of DOACs found that patients were less satisfied with information provided in comparison to warfarin, raising concerns that their adherence to these important medicines may decrease. This work also demonstrated that type of information patients required differed from what clinicians provided during the consultation, particularly around issues of necessity and concerns about medicines.
In order to supplement consultations, and allow patients (and family members) to access information quickly and in a timely manner each short video clip (1-2 minutes in length) was designed to answer one specific question, allowing patients to only receive the information they require. The 12 questions were taken from validated data sources regarding patient's information needs and the answers were reviewed clinically by the MDT and a health psychologist.
Evaluation of patient satisfaction of the videos (measured via the satisfaction with information about medicine scale, SIMS) demonstrated those who watched the videos were more satisfied with information provided. For inpatients, the patient satisfaction improved from 50% (videos not watched) to 94% (videos watched) and for outpatients patient satisfaction improved from 65% (videos not watched) to 96% (videos watched). These results demonstrate that the videos are helping to bridge the information gap.
This project has demonstrated the need to ensure information is available on multiple different platforms, as the way in which information is accessed has developed over the years. Further work is needed to promote these videos, to ensure they are accessible to a wider range of patients.
Funding was received from the cardiovascular department at Guy's and St Thomas' in a Dragons Den style competition.
The videos are available to view at: www.guysandstthomas.nhs.uk/anticoagulation
Best comprehensive Thrombosis Management Centre
The Ambulatory Thrombosis, Atrial Fibrillation and Anticoagulation Service. Chelsea and Westminster NHS Trust
In 2014, patients with Thrombosis and Atrial Fibrillation had been managed across the hospital in a relatively inconsistent fashion, both as inpatients and outpatients. We knew that patient pathways were inefficient, staff were dissatisfied and patient experience was sub-optimal. We also knew that we could make improvements, but that we would have very little resource in order to do so.
In October 2014, the Ambulatory Emergency Care unit (AEC) was opened and was able to take over the management of the majority of patients with DVT (Deep Vein Thrombosis). The team, led by Dr Ashkan Sadighi and Dr Emma Rowlandson, were then able to focus on specific areas of the patient pathway to improve efficiency, safety and patient experience. Further streamlining of services led to the development of the PE (Pulmonary Embolism) pathway, the AF (Atrial Fibrillation) pathway and the improvement of the DVT pathway.
Bringing them all together we launched the Thrombosis Service at the beginning of 2018. The Thrombosis pathway is consultant led by Haematologist Dr Natasha Wiles and includes a weekly multidisciplinary meeting in which all patients with a thrombosis are discussed. This facilitates real time changes in management, medication review and timely referral to other key specialties. The patients are then followed up in a direct access Thrombosis clinic located within the department which has significantly reduced the time to first clinic appointment. The psychological and clinical impact of a detailed discussion at the first clinic appointment early in their thrombosis treatment has been highlighted by patients as a major improvement in their experience and quality of life.
In 2016, Cardiologist Dr Sadia Khan set up an Ambulatory AF pathway in which all patients diagnosed with AF followed regardless of where they first presented. The pathway was launched on site and then rolled out to Primary Care. All patients are now referred to AEC to be assessed, investigated and where appropriate, their anticoagulation is initiated by the team. The pathway has already won two awards its first year, the Atrial Fibrillation Healthcare Pioneers award and a North West London Prize for Quality Improvement In Action award. Since its initiation we have improved the care of patients presenting with AF and have audit data to show reduced time to anticoagulation, reduced admissions and length of stay for patients on the pathway.
The impact of the Thrombosis and AF pathway has been positive not only for the patients, but also the staff delivering care, the local GPs and the organisation as a whole.
We have learnt that implementing change is challenging, particularly when no additional resource is directly available to do so, but with strong team work and perseverance, a surprising amount can be achieved. Focusing on improving efficiency of patient pathways, rather than cost and complex negotiations with commissioners can have the best results for patients and the overall health economy. We have made huge progress with the development of these services but are only at the beginning of a continuous journey of improvement.
The Centre Best Able to Demonstrate Adherence to NICE Quality Standards for Atrial Fibrillation
Affinity Care has provided a community based anticoagulation service for its registered patients for over 15 years and to the wider patient population of Bradford and Airedale for the past 10 years. Delivered through a highly skilled, multiple professional team the service has grown to now have 878 patients on its caseload, providing in the region of 6,000 appointments per year, delivered over 6 different community sites for ease of access for patients.
Our model is purposely built to allow new sites to be added therefore this initiative is easily adapted to other services and clinics. A key aspect being around its infrastructure of robust common protocols, shared learning and audits. A central hub on SystmOne clinical system and use of INRstar dosing software allows for many remote sites to be working in a consistent high quality and safe way.
The clinical guidelines produced by Dr Fay and the anticoagulation protocol developed by Sr Jane Patrickson both incorporate NICE guidance and have been taken on board by other anticoagulation services. They include patient centered care, a personalized package of care and information, and using appropriate clinical tools such as CHA2DS2-VASc and HAS-BLED to assess risk of stroke and bleeding. Within our service we give prompt appointments and refer to specialist management in-house.
All our clinicians have KardiaMobile devices, so we can capture a medical-grade EKG in just 30-seconds. We then know instantly if the heart rhythm is normal or if atrial fibrillation (AF) is detected in the ECG. Any abnormal results are sent to the cardiology team for assessment and the patient is invited for an appointment if AF is diagnosed.
A robust recall system ensures patients on DOAC medication are regularly monitored in an appropriate timescale depending on their blood results. The clinical system also highlights patients who are overdue a review and this is managed by the team on a daily basis. Assistant Practitioner in Cardiology, Bernie Cahill is indispensable in ensuring safe administrative systems.
We now also provide any patient who is suitable for self-testing with a machine and free test strips so they can check their INR at a time and location suitable for them. An App called Engage which is downloaded onto their mobile telephone, iPad or computer alerts them when to test, sends the result directly to our software using bluetooth which can then be dosed by the anticoagulation professional and the daily dose is sent back to the patient.
Home testing is not an original concept but until our intervention it was only available to a select few individuals who were eligible for a free machine or patients who were willing to buy their own machine at considerable cost. Not only has this initiative cuts costs in terms of specialist nurse time, HCA appointments and home visits, it has also improved safety for patients who can now test in their own time, it has empowered them to take ownership of their testing. This has improved their overall % of time in therapeutic range which as evidence demonstrates improves patient safety.
Redbridge CCG - Improving Anticoagulation Prescribing for Stroke Prevention in Atrial Fibrillation and Optimising Medicines for Cardiovascular Risk
For Redbridge, the Quality and Outcomes Framework (QOF) for 2016/17 showed 23% (560) of AF patients with a CHA2DS2VASc score of 2 or more were not anticoagulated, in comparison to the national average of 19%. In addition, the Sentinel Stroke National Audit Programme (SSNAP) demonstrated that the number of strokes in patients with known AF but not anticoagulated was 37% for Redbridge in 2016/17.
A quality improvement programme was developed in collaboration with Redbridge Clinical Commissioning Group (CCG). The purpose of the programme was to:
- Eliminate inappropriate antiplatelet monotherapy in AF
- Increase anticoagulation uptake in individuals with a CHA2DS2VASc score of >2 (including reviewing those previously excepted from treatment);
- Avoid further delays in treatment initiation by bypassing the referral into secondary care and supporting GPs in anticoagulation initiation in primary care;
- To treat patients closer to home.
Using a software decision support tool (APL-AF tool) a specialist haematology independent pharmacist prescriber, from secondary care identified all AF patients at high risk of stroke (CHA2DS2VASc score>2) from 44 GP practices eligible for anticoagulation treatment from May 2017 to May 2018. Joint GP-Pharmacist consultations were conducted with patients to optimise their therapy and support training of GPs in providing a legacy of primary care initiation of anticoagulation. Recommendations to optimise blood pressure and lipid control were also made.
The confidence of GPs initiating anticoagulation and their ability to challenge the older aspirin recommendations to anticoagulation therapy was a difficulty addressed with the programme. To further support education and training for GPs, four educational sessions on anticoagulation were carried out by a consultant pharmacist as part of the protected learning events. For on-going support; a weekly teleconferencing meeting with a multidisciplinary team (MDT) consisting of a cardiologist, haematologist and GP with specialist interest in cardiology, with the purpose of:
- Escalating challenging patient cases without a formal referral
- Avoiding delay in clinical decisions influencing outcomes
- Clarifying diagnostic uncertainties
The quality improvement measures were recorded centrally by the Clinical Effectiveness Group for each GP. The outcomes exceeded expectation;
- Anticoagulation prescribing improved by 17%; compared to 1.5% increase in the previous year
- 138 fewer patients on inappropriate antiplatelet monotherapy
- 34.5% of patients had statin therapy optimised and 14.3% of patients had BP therapy optimised
The success of the AF improvement programme has been recognised as an exemplar model of care by the local Academic Health Science Network and will develop this as a sustainable, longer term model by engaging with practice based clinical pharmacists (PBP) recruited as part of the NHS England work stream. This model can also be replicated in managing other long-term conditions such as asthma, diabetes, etc. Success was achieved by engaging with stakeholders, adopting a multidisciplinary approach, using digital technologies and innovation to support decision making.
Sentinel Healthcare - The safe and effective management of stroke prevention in AF
NICE recommends that patients with a diagnosis of atrial fibrillation (AF) are offered anticoagulation, or have their anticoagulation reviewed, at least annually.¹ To implement these guidelines Sentinel Healthcare partnered with Interface Clinical Services to deliver a pro-active review to enable the safe and effective management of stroke prevention in AF.
The AF service was designed to improve all aspects of patient care through the correct identification and diagnosis of AF, to ensure patients are optimally anticoagulated. This was done through a combination of clinical system interrogation, clinical reviews and patient education, delivered through a pharmacist-led team. This enabled Sentinel to:
- Identify and project actual disease burden.
- Stratify AF patients according to their level of stroke risk whilst ensuring that patient coding is reflective of actual levels of risk. Stroke risk profiles were based on CHA2DS2-VASc scoring, in line with current guidelines.
- Support the therapeutic management of stroke risk in AF patients in accordance with risk profile, current guidelines and practice preferred anticoagulation strategy.
- Provide patients with educational material relating to stroke prevention in AF in the form of treatment compliance support and lifestyle advice.
Without the additional resource and expertise that this programme provided, it would not have been possible to implement NICE guidelines and quality adherence as efficiently and proactively. The service was re-audited after one year to demonstrate the impact and legacy of the service. This showed that throughout the federation:
- The AF clinical register had increased from 2,990 to 3,313 (10.8%).
- The number of patients with a CHA2DS2-VASc ≥ 1 currently without anticoagulation had fallen by 219 against a prevalence increase of more than 400 patients.
- 283 patients with CHA2DS2-VASc ≥ 1 were initiated onto an anticoagulant (vitamin K antagonist or DOAC).
2,990 patients were stratified from the clinical register, this included 648 recommended interventions:
The collaborative approach between Sentinel, Sentinel Surgeries and Interface with support from the South West Academic Health Science Network, NEW Devon CCG and Industry made for an innovative approach to deriving sustained, positive anticoagulation outcomes within primary care.
To further support the positive impact of the project, a further 16 practices are now participating in the initiative. This means that in total 32 practices will have benefited from the additional resource and clinical expertise the project facilitated.
Best Work in Prevention of Hospital Acquired Thrombosis (HAT)
Abertawe Bro Morgannwg University Health Board (ABMUHB) - Nurse Led Thromboprophylaxis Re-Assessment Tool
English Hospital Trusts attached a CQUIN payment to Venous Thromboembolism (VTE) Risk Assessment (RA) to achieve a 95% uptake. Welsh Health Boards’ have no financial incentives.
Since 2012 a Nurse led Thromboprophylaxis (TP) Re-Assessment tool has been used on all wards in the Princess of Wales Hospital Bridgend. On admission Clinicians complete and document a Thromboprophylaxis Risk Assessment. Nurses hold the key in ensuring TP Re-Assessment takes place during the patient’s admission.
The tool has a 2 fold benefit:
- Nurses prompt clinicians to complete TP risk assessment improving number of patients risk assessed and treated appropriately.
- Ensures all patients are re-assessed daily or as their condition alters.
The TP Re- Assessment tool was added to the Welsh Care Metrics in 2013 as a tool to measure quality of care at ward level. Monthly indicators include:
- Number of patients risk assessed for VTE on admission
- Number of patients re-assessed for VTE during admission
Root Cause Analysis (RCA) is undertaken in all reported VTE’s in hospitalised patients, or within 90 days of discharge, case notes must confirm one or both of the following:
- A documented risk assessment
- Appropriate Thromboprophylaxis prescribed
Confirmed Hospital Acquired Thrombosis are reported to the admitting Consultant using the DATIX incident reporting system. This completes the investigation and provides feedback to improve future performance.
- Governance arrangements are overseen by unit quality and patients safety group
- Assurance arrangements overseen through monthly performance reviews and monthly Quality and Safety committee
- Data displayed on HAT dashboard
Since the implementation of the Nurse Led Thromboprophylaxis Re-Assessment Tool, we can now clearly demonstrate a consistent 85%+ uptake of TP RA and a consistent reduction of the number of HATs in the Princess of Wales hospital.
Ashford and St. Peter’s Hospitals NHS Foundation Trust (ASPH) – VTE Prevention in-Patient Service, Education and Awareness Campaign, Thrombosis Week 2018
The VTE Prevention team visited clinical and non-clinical areas of the hospital during Thrombosis Awareness Week 2018, and used games to raise awareness and highlight risk factors such as: the clot and spoon race; catch the clot and the VTE conga (evidence of which can be seen on twitter!). Staff, patients and visitors all got involved, with feedback being positive from all who took part and in particular patients reported feeling more Involved in their care in relation to VTE Prevention.
Interactive teaching and awareness methods were also utilised, such as the use of “clot shots”. The “clot shots” were red jelly shots designed to be a tactile aid, demonstrating the consistency of a DVT and to stimulate discussion and grab attention.
In 2016, the VTE Prevention team created a video compilation called “What does VTE mean to me?” Members of Trust staff, both clinical and non-clinical were asked to write on a flashcard what VTE meant to them. The video was shown at the Trusts annual VTE Conference and is available on the Trust intranet site. It created a lot of engagement and raised the profile of VTE while creating an emotive visual tool. This idea was repeated again during Thrombosis Awareness week 2018 and again proved to be very emotive.
A sponsored dance-a-thon was arranged to complete Thrombosis Awareness Week 2018. The dance-a-thon was held in the main entrance of the hospital with live music from the Hospital radio station; information stands and Salsa demonstrations and lessons. The event generated a buzz around the Trust, raising the profile of VTE amongst staff who were coming to the dance-a-thon to learn more about VTE. The public and the patients got involved and went away with a better understanding of what VTE is and what the risk factors are.
The VTE Prevention Team widely utilise social media platforms to raise awareness of VTE amongst staff, patients and the wider community. Twitter and Facebook were used to promote Thrombosis Awareness Week 2018 at ASPH and the resulting engagement came from as far afield as America.
Salford Royal NHS Foundation Trust
What we did and why:
Thrombosis is a global killer and major health burden for the UK across all specialties. However, standard prophylactic measures carry risk, leaving clinicians without specialist interest often uncertain regarding prevention measures.
As a new thrombosis committee forming in 2016, we sought to raise awareness of this disease across a tertiary specialist organisation and implement a multifaceted quality improvement strategy. Our aim was to improve patient safety across all areas of thrombosis/anticoagulation and embed organisational change through the following clinical and educational measures:
- Use of the Global Digital Excellence initiative to develop decision support software; this allows for tailored Hospital Acquired Thrombosis (HAT) risk assessment with bespoke specialty guidance, automated weight based prescribing, renal safeguards and choice architecture.
- Creation of a cross specialty thrombosis committee with links across the integrated care organisation, to facilitate a standardised and reliable assessment process.
- Development of a sustainable education and awareness strategy throughout the organisation, without reliance on individual champions.
All specialties see challenging cases of venous thromboembolic disease; we wanted to make it easier for clinicians at every level to understand the best evidence in thrombosis care, and to apply it reliably at the bedside.
Outcomes and Impact:
Our key HAT intervention was the development of an intelligent electronic HAT Risk assessment tool embedded as part of the patient record. This tool provides bespoke real time clinical guidance at the bedside by parent specialty, including rapid links to trust protocols and tailored prescribing information. The software automatically pulls through relevant bloods results and weight, then links to a parent specialty agreed prescribing bundle. The tool offers opportunity for reassessment at regular intervals with prepopulated fields to reduce workload, and contains a variety of red flags to warn against co-prescribing.
Since introduction of this tool and additional delivery of the strategic points above, we have seen sustained improvements in the quality of HAT risk assessment and a consistent reduction in HAT cases at Salford. We have also substantially reduced the proportion of HAT deemed preventable following independent root cause analysis, from over 20% at project inception to consistently <5% over the most recent 6 months.
What we learnt:
This opportunity to lead improvements in thrombosis and anticoagulation at Salford Royal has highlighted the importance of cross specialty working, choice architecture in design and supplemental education. We have worked hard to generate clinical buy in across the trust and used multiple clinical forums to ascertain what practitioners want from HAT risk assessment and how to make it work for them.
We have also recognised the advantages of electronic risk assessment within this project; this has allowed rapid adaptation to changes in NICE guidance or relevant advances in specialist working.
Lastly, our additional work has led to Salford being adopted to the national exemplar centre network for thrombosis care. This has provided a great opportunity for shared learning, dissemination of best practice and regular networking with experts in VTE prevention. We look forward to being a key part of the network moving forwards.
Whittington Health NHS Trust - Reducing inappropriately suspended VTE prophylaxis through a multidisciplinary shared learning programme and electronic prompting
Venous thromboembolism (VTE) is a major complication of protracted hospital stay with approximately 10% of all hospital deaths caused by VTE. Following root cause analysis of isolated serious incidents of hospital acquired venous thromboembolism within the trust, several contributing factors including incorrect clinical rationale of suspension and delay recommencement of prophylaxis were identified.
An audit was carried out on all medical inpatients with VTE prophylaxis suspended at Whittington Hospital in November 2017. The hospital electronic prescribing system was used to identify the patient cohort, followed by manual review of hospital records to identify rationale and duration of suspension.
The data showed that 29.4% of all patients with VTE prophylaxis withheld had a period of inappropriate suspension. The main reasons were as follows:
- Delay in restarting prophylaxis following clinical procedure which carried risk of bleeding.
- Delay in resumption following CT head which did not demonstrate intracranial bleeding after a fall with suspected head injury.
- Suspended following a suspected haemorrhage (such as gastrointestinal bleeding), but not restarted once the risk has dissipated.
- Suspended due to biochemical abnormalities (raised INR or low platelets), however delay in restarting once these had normalised.
Collaborative, multidisciplinary approach to share learning and implement new changes.
Learning from the audit result were shared and discussed across different forums and changes were implemented to facilitate long term sustainable improvement;
- Presenting the audit at multiple forums, including junior doctors teaching sessions, audit and quality improvement sessions, patient safety forum, thrombosis committee and lectures for pharmacists.
- Review of hospital guideline by haematologists and thrombosis committee, providing clear guidance, such as which procedure requires suspension of prophylaxis. The VTE prophylaxis contraindications are printed as a quick reference guide for all ward pharmacists and clinical team.
- Ward pharmacist receiving an alert via email on patients who had their VTE prophylaxis suspended. This will prompt discussion with clinical team about whether the clinical contraindication was appropriate and facilitate recommencement of prophylaxis once risk has dissipated.
A re-audit of in May 2018 showed a statistically significant improvement, with a 20% actual reduction, P<0.0006 of VTE prophylaxis being suspended inappropriately, through shared learning, education, electronic prompting and discussion between multidisciplinary teams (See Figure 1).
FIGURE 1: Percentage of patients with inappropriate VTE suspension pre and post intervention by category
Best Work in the Prevention and Treatment of Cancer Acquired Thrombosis (CAT)
Royal United Hospitals Bath NHS Foundation Trust
In 2017, the Royal United Hospital (RUH) Anticoagulation Team conducted an audit over 3 months to review the management of cancer associated thrombosis (CAT). This audit showed that management was inconsistent and unsafe. Patients presented in different areas including ED, oncology and primary care. This meant management varied significantly. There was no standardised follow up or process for decision making on duration of treatment, resulting in some patients stopping treatment too early and others continuing treatment unnecessarily. Only 4/12 patients (33%) on dalteparin received an appropriate dose reduction at 1 month (Figure 1). Communication between primary and secondary care, including utilisation of a shared care agreement was poor. Only 1/12 of patients (8%) had communication to their GP of a treatment plan (Figure 2). Consequently, a new CAT telephone clinic, treatment pathway and patient information leaflet were implemented.
Figure 1: No. patients on dalteparin who received a dose reduction at 1 month (where appropriate) (N=12/29)
Figure 2: No. patients on dalteparin who had a treatment plan communicated with their GP after initiation (N=12/29)
The clinic is led by an Anticoagulation Pharmacist with support from a Specialist Nurse and two Consultant Haematologists. Clinicians can refer any adult cancer patient with CAT. All patients are reviewed at one, three and six months via a fifteen minute telephone appointment. Three months after starting the clinic we carried out a re-audit. In the first three months 38/44 patients (86%) with a new CAT were referred. For patients treated with dalteparin (N=30), an appropriate dose reduction at 1 month was made in 100% of patients. A treatment plan and agreement to participate in shared care, where appropriate, was communicated via letter to the GP in 100% of patients (N=38).
Expenditure on dalteparin by the RUH has reduced by £1500 a month due to increased uptake of shared care. Overall feedback from 13 patients was positive: 92% felt they received sufficient information on their diagnosis/treatment. However, 2/13 patients would have preferred a face to face consultation, at least at the start of treatment. At present we are unable to offer face to face reviews and the majority of patients prefer telephone consultations. A future option may be to use Skype to conduct some consultations. The CAT clinic made numerous interventions over the three months including decision making on alternative anticoagulation (See Figure 3).
Figure 3: Breakdown of indications requiring intervention by the CAT clinic team (N=16)
Since implementation, GPs are more informed and patients obtain their medication in the community. Patients have a designated support network in place to help manage their condition. The interventions made demonstrate the impact of the service on improving patient safety and ensures a patient cantered approach. Ensuring patients have a review at three and six months means there is a robust decision making process on the need for long term anticoagulation. The results of HOKUSAI-VTE-cancer and the data from the Select-D trial means Direct Oral Anticoagulants (DOACs) are likely to become an option in CAT. Understanding interactions between DOACs and cytotoxic agents, their effects on renal/hepatic function, assessing bleeding risk and patient preferences will be vital to ensuring patients are on the most appropriate treatment. The CAT clinic means there is a specialist team who are prepared to incorporate this new data into a patient centred service.
Best On-Going Management of Thrombosis by a Community Based or Primary Care Service
Liverpool Anticoagulation Service - Community
Liverpool Anticoagulation Service operates 37 clinics across 23 sites, with patients being seen within 1 mile of their GP surgery or in their own homes.
The service has in excess of 83,000 patient contacts per year, supports patients who self-test and operates an advice line for patients and healthcare professionals. The team is jointly led clinically by a specialist nurse and pharmacist, assisted by an operations manager and comprises of nurse specialists, pharmacists, pharmacy technicians and admin.
A Leadership Pulse Check demonstrated the team feel valued with individualised training, education sessions, peer review, team meetings, weekly team bulletins and clinical supervision. Should significant events occur within the service, a ‘no-blame’ culture is employed and the question: “What is responsible?”, rather than “who” is asked.
Location of clinics in Liverpool Anticoagulation Service
Location of clinics in Liverpool Anticoagulation Service
Prior to establishment of the service, patients often had a venous blood sample taken from their arm and were then dosed by telephone if they were unstable or had to await their result and dose in the post. In the current service, patients have been moved out of the hospital into convenient community clinics and are given an appointment time of their choosing. They are seen face to face by a clinician and are tested using point of care devices which provide an instant INR result from a small sample of blood from their finger.
The clinician assesses the result, advises the patient of the correct dose of anticoagulant medication to take, provides them with appropriate advice and agrees their next appointment before they leave the clinic. Housebound patients receive a service of equal quality in their own homes. The high standard of care afforded to patients under the service is reflected in 99.8% of patients having rated the service as excellent or good and the many compliments received on a regular basis from patients.
Face to face consultation with the patient has allowed clinicians to review patients holistically at each consultation and to identify any medical or social issues that may be impacting on their anticoagulation control and ongoing care. As such, the clinicians within the service frequently engage with the patient’s GP, colleagues in secondary care, social care organisations, medicines management and safeguarding. Patients also receive an in-depth annual review. These things have resulted in an increase in time in range from 68.5% in June 2015 to 70.8% in June 2018, which is significantly above the national average. in the community and have demonstrated improved clinical and patient outcomes.
Patients can be referred into the service directly from acute hospital trusts through electronic means or from their GP and are always seen within 5 or 10 working days respectively, but often sooner according to clinical need. Non-medical prescribers within the team provide the patient with a prescription at initiation of treatment and also manage patients peri-operatively by providing bridging therapy and an individualised bridging plan for planned procedures. As a team we have overcome and continue to overcome logistical barriers to deliver a high quality safe and convenient service for highly complex patients in the community and have demonstrated improved clinical and patient outcomes.
VTE Hero Award (public nomination)
Sister Katie Bishop, Anticoagulation Nurse specialist at Basildon & Thurrock University Hospital
The VTE Hero Award invited nominations to be submitted from the general public, patients and carers who has received care or been aware of a family member/friend who has received care from a healthcare professional within the NHS who has gone above and beyond to deliver care within the field of anticoagulation.
This award celebrates an individual who has made a significant contribution to the anticoagulation service including the provision of resources and support and the benefit this brings to patients using the service and who has delivered an exemplary service, that:
- Placed value and emphasis on patient experience, understanding, wellbeing and improved outcomes.
- Has demonstrated innovation and dedication.
- Delivered care in a way that is over and beyond their job specification and has brought considerable benefits to all those benefiting or involved with the service.
Unsung Hero Award
Dr Jason Kendall, Consultant in Emergency Medicine, North Bristol NHS Trust
New for 2018, the Unsung Hero Award invited nominations from the Judging Panel for an individual who has played a critical and integral part in an anticoagulation service demonstrating continuous positive behaviour and practices which are embedded in their disciplines.
The individual will represent dedication, exceptional leadership, commitment to collaboration and value the importance of team work, with priorities including:
- Patient safety
- Involving patients
- Providing support to colleagues and engaging with patients to put them at ease
- Instil enthusiasm and determination to deliver the best in colleagues and team members
In short, an “amazing person, patient focused, a great leader and passionate about reducing VTE events.”
The Judges Award
Andrea Croft, Lead Advanced Practitioner at the Princess of Wales Hospital, Bridgend, Wales
The Judges Award is an annual award made by the Judging Committee to an individual or team who have demonstrated exceptional drive and leadership in establishing an exemplar anticoagulation service.
In making the award, the Judges have reviewed data measures along with personal endorsements on the measured and real differences the award winner has made to patient safety, experience and outcomes through their service provision.
The Judges have also reviewed evidence of innovation and shared learning undertaken by the award winner to extend understanding and knowledge across multiple healthcare professional teams both locally, nationally and globally.
Consideration has also been given to evidence of personalised care that each patient has received as a result of this exceptional healthcare professional, and undertaking to ensure all patients, whether at risk of venous thromboembolism or having been diagnosed with a thrombotic event, are provided with sufficient information tailored to their needs, and opportunity to discuss and raise questions to support their well-being alongside physical recovery.