June Ward
Haemophilia / Anticoagulant Nurse
Ward 34 day area
Ninewells Hospital
[email protected]
Warfarin reduces rate of stroke
Warfarin remains one of the most dangerous medicines causing harm
Tayside has one of the most sophisticated services offering near patient testing,
primarily nurse- led services with some pharmacy practitioners
Standardised training, agreed shared dosing protocols, audit of practice
Acute services and community settings
5700 patients all ages, abilities and literacy needs
• Why we got involved & what we expected
• Engagement & collaboration between teams
DCAS, P&K, NWS, Phyllis & her team
• Reviewed existing information available video /
concertina leaflet
• Feedback to Scottish Patient Safety Programme influencing change to future patient information
booklet
• Patient involvement- focus groups
• Measure our impact
• Reminders / Training for staff re
Teachback methods, site visits by
Phyllis & Angela
• Adapting new patient checklist
• Review new patient knowledge at
1st & 2nd visit
•Patient focus groups
Improving self-management with high
risk medication
• Focus groups main themes:
• Change name to ‘Warfarin’ rather than ‘Oral
Anticoagulant Therapy’
• Pages on patient information booklet with
unnecessary information make the book too long
• One or two books - record book and information
book - preferences varied
• Alert card - too big and needs to be more robust
Improving self-management with high
risk medication
“The books are good for back up but I found the
spoken help I got at the beginning most useful”
“I forgot to take it [Warfarin] at 6 o’ clock and wasn’t
sure if I could take it at midnight”
“I didn’t understand why it was important to take it
at 6 o’ clock”
Yellow Book being updated to simplify recording and information
pages
Checklists being tested by Anticoagulation Team with tick box to
ensure use of Teach-back at appropriate points T √
Results
Question and expected answer
Response rate
comments
1.
Why do you use warfarin
Expected: to keep my blood thin, prevent clots
or stroke
12/12
to thin my blood, Blood clots, combat blood clots caused by AF,
mechanical heart valve, irregular heart beat, for blood, heart
2. Your target range
Expected: 2-3, 2.5-3.5, 3-4.5
8/12 (67%)
1 don’t know, 1 not valid range, others valid range
3. Duration
Expected: 3 mths , 6mths longterm / lifelong
11/12 (92%)
10 pts longterm/ lifelong 1
1 year
4. Which foodstuffs to limit
Expected: spinach, broccoli, kale, sprouts,
cranberry & pomegranate juice, dark green leafy
veg
9/12 ( 75%)
Eggs, pomegranate, sprouts, greens, grapefruit, cranberries,
pomegranite, dark green leafy veg, excess garlic, YES
5. Alcohol limits
Expected: 2 units per day
12/12 ( 100%)
No more than daily advised 2 units, none, 1-2 units, 2 units per day, little
one, very little 2 units weekly
6. Use aspirin / NSAIDS with warfarin?
Expected: avoid unless advised by doctor
9/12 (75%)
9 avoid don’t use
7. Inform clinic starting new medicines
Expected: Contact clinic to arrange review
11/12 (92%)
11 yes contact clinic
8. Inform dental, surgeons, pre procedures
Expected: Inform them use of warfarin
10/12 (83%)
10 yes inform
9. Who to contact if unexpected bleeding
problem
Expected: GP, NHS 24, warfarin clinic
10/ 12 ( 83%)
GP, Doctor or NHS, Hospital or doctor, 999, warfarin nurse, cardiology,
Warfarin team, YES
10. How long have you used warfarin
12/12 ( 100%)
3 weeks – 5 years
11. Comments on clinic
6/12 ( 50%)
Staff are friendly and helpful, everything lovely, very informative, its
perfect, best ever, treatment very good and team excellent.
(100%)
What next?
• Continue focus on teach-back methods within teams
• Review education / patient knowledge at agreed
time frames: 1st , 2nd visit, 3 months, 6 months,
annually
• Await new warfarin book???
• DVD’s , Internet??
• Our patients who attended focus groups are engaged
and would like to be involved in future projects
• Feedback to our staff > motivated and engaged