Audit of NOAC patients previously on warfarin Sue Bacon - - PowerPoint PPT Presentation

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Mar 20, 2024 374 likes •527 views

Audit of NOAC patients previously on warfarin Sue Bacon Anticoagulation Nurse Specialist North Bristol Trust History of NBT AMS Prior to 2009 dosing by haematologist/BMS/MLA Small team based at FHY using DAWN Sept 2009 CNS

SLIDE 1

Audit of NOAC patients previously on warfarin

Sue Bacon Anticoagulation Nurse Specialist North Bristol Trust

SLIDE 2

History of NBT AMS

Prior to 2009 dosing by haematologist/BMS/MLA –
Small team based at FHY using DAWN
Sept 2009 CNS recruited and haematologists took

backstage

2010 AMS merged with dosing at SMD hospital who

used yellow books and dosed by haemtologists only, who then also disappeared

Workload increased!
2011 VTE nurse recruited but only 1.5 days anticoag

SLIDE 3

North Bristol Trust

Shared care with GPs
Cover North Bristol and South Glos
Postal service
5,200 patients approx
Used to dose about 500 plus a day but recently

450 daily (approx)

I WTE CNS and one PT (1.5 days) although fills

in three days a week to cover annual leave etc

BMS ‘of the day’
2 band 2 MLA – admin and dosing within SOP

SLIDE 4

NOACS

Dabigatran (RELY 2009) - AF
Rivaroxaban (ROCKET and EINSTEIN)

AF and VTE

Apixaban (ARISTOTLE and AVEROES)

AF

Edoxaban – coming soon

SLIDE 5

Why audit NOACs?

To understand how many patients have

transferred

To look at the transfer process and ensure

best practice followed

Feedback the results to the GP surgeries

to improve patient care

SLIDE 6

How?

Using the reporting function on the list

view- with a little help from DAWN

Downloading the data into excel
Sorting by reason for stopping (could

DAWN give us a drop down menu to make this easier?) – this has already been addressed

SLIDE 7

Results

Downloaded data for the last 2 years
3438 patients stopped for a variety of

reasons

SLIDE 8

anaemia apixaban dementia high INRs low platelets non compliant previscan acenocoumarol unwell NOAC allergy palliative pt choice falls bleed cancer error antiplatelet self test LMWH RIP moved DAB GP DNA RIV no reason End

SLIDE 9

Results re reasons for stopping

Dementia
Falls
Antiplatlets
Allergy to warfarin
High INRs
These reasons are not reasons for

stopping anticoagulation in patients with AF and should perhaps be investigated

SLIDE 10

NOACs

Of the 3428 patients stopped over the two

years:-

461 patients onto NOACs:-
1 - apixaban
164 - dabigatran
296 – rivaroxaban

SLIDE 11

Problems identified

No firm data as yet but those investigated –

inappropriate management of transfer – ie low INRs

GPs stopping patients to transfer
INRs - <3 for RIV and AF
INRs - <2.5 for RIV and VTE
INRs - <2.0 for DAB and APIX
Most patients could just transfer immediately esp those

not taking

Information available to all GP on the BNSSG website

SLIDE 12

Further problems picked up

Remember NOACs only licensed for NON-

VALVULAR AF and only RIV for VTE

22/164 dabigatran - not licensed

VTE/cardiomypoathy/arterial embolus and mechanical valves or valve repair (3)

10/296 rivaroxaban – arterial

disease/cardiomyopathy/mechanical valves or repair (3)

SLIDE 13

Action?

Consultant to write to GPs about valves
CNS to check future letters from GPs
Further formal audit – junior docs?

SLIDE 14

Good paper:-

www.NOACforAF.eu
Practical guide on the use of NOACs
Free to download
Patient alert card
Booklet available soon