Anticoagulation Department
Anticoagulants are one of the classes of medicines that most frequently cause preventable harm therefore the main aim of the Anticoagulation service is to ensure that safe, effective Anticoagulation care is provided to all patients this includes both VKA antagonist and DOAC medications.
Types of services offered
Anticoagulation Service
The Anticoagulation service uses 4s DAWN computer assisted dosing software package. This package supports the service in relation to International Normalised Ratio (INR) monitoring and dosing, Total Time in Range (TTR) review, alongside these two key functions 4s DAWN is also able to support various audit functions including the review of INRs greater than 8, and an analysis of the number of monthly referrals. In 2020 the service will hopefully be migrated over to the latest DAWN version which, amongst other improvements, will allow a smooth emailing process to General Practitioners also providing emailed dosing advice to patients which not only will be a significant cost saving to the trust but most importantly a patient safety initiative as all patients will have minimal delay in receiving dosing instructions.
All patients referred to the service for treatment with VKA, DOAC or LMWH receive an individual educational session where the reason for the Anticoagulation is clearly explained to the patient, risks are discussed and telephone contacts supplied. All patients receive written information about the Anticoagulant they have been prescribed and are also given an alert card, following the education session patients are asked to consent to treatment.
VKA anticoagulants require frequent monitoring and dose adjustment to maintain a therapeutic level and minimise bleeding risks, the service aims for a total time in range (TTR) for all patients prescribed VKA of 65% or more, a clear SoP is available for nursing staff on how to safely dose a patient prescribed VKA.
Since the DOACs were licensed in 2012 a drive for the service has been to ensure that all patients are prescribed the correct Anticoagulation for their clinical needs. Those patients who the Anticoagulation deem appropriate for DOAC management are managed in two ways depending on the indication of Anticoagulation; if the patient is prescribed a VKA for VTE the patients is referred to the Haemostasis and Thrombosis MDT for discussion about the preferred Anticoagulation choice, however if the patients is prescribed warfarin for AF then the GP is sent a letter to consider a DOAC.
All adverse events are investigated. The service reviews all INRs greater than 8 and 6 on a monthly basis and investigates reason for the elevation and then reports these findings to the VTE steering group.
Patients requiring anticoagulation, as outpatients, will be educated, managed and treated either at Warren Hill House at Kettering General Hospital at Corby Diagnostic, Nene Park, at Isebrook, Wellingborough.
Patients are managed using the latest guidance from the British Committee for Standards in Haematology (BCSH), the National Patient Safety Agency (NPSA) and the National Institute for Clinical Excellence (NICE).
DVT clinic
This clinic runs daily from Warren Hill House.
Patients are referred either externally by General Practitioners or internally from Emergency Department (ED), Medical Same Day Emergency Care (SEDC) or other specialities for example Oncology.
The DVT service has access to ten Doppler Ultrasound scanning slots.
Patients are assessed, scanned and treated on the day of attendance, all positive cases are referred to MDT for further discussion and treatment plan agreed
Anticoagulation Clinics
Daily Domiciliary Clinics
A domiciliary phlebotomist attends homes of housebound service users to undertake an INR using a Near Patient Testing (NPT) machine.
Once the INR sample is obtained the result is phoned through to the department and the dosing decisions written in the patients ‘yellow’ book or if stable brought back/emailed to the department the INR is then dosed retrospectively and posted to the patient via the ‘economailer’ system. Any INR less than 1.5 or greater than 4 is taken venously and sent to the laboratory to be processed and compared with the NPT results