Managing >8 INRs in an Anticoagulation clinic. Sean OBrien - - PowerPoint PPT Presentation
Managing >8 INRs in an Anticoagulation clinic. Sean OBrien Anticoagulation Specialist BMS Blackpool Hospitals Trust Managing >8 INRs in an Anticoagulation Clinic Overview of service (ADAS) Vitk Policy at Blackpool
Overview of service (ADAS) Vitk Policy at Blackpool Overview of Study, including exclusions Patients by Clinic (location) Patients by >8 reason Demographics Treatment options and outcomes Domiciliary patients Potential Savings, (Patient and Trust) Key learns and improvements. Any Questions?
ADAS is a consultant lead “point of care” service
The service is staffed by State Registered Specialist
We use KC4 4 channel analysers with Coaguchek XS as
Near patient testing performed by Medical laboratory
6200 active patients 16 outreach clinics dosing up to 550 patients daily 750 domiciliary patients
1 ADAS manager 2 full time Specialist BMS’s 1 Full time DVT nurse 14 rotational Haematology BMS’s 20 Medical Laboratory assistants 2 fiat Multiplas, 1 Berlingo and 5 Clio’s!
2 Specialist BMS’s to dose 4 Lab assistants to clerk patients and capillary sample 2 KC4 analysers with Coaguchek XS back up 1 Fiat Multipla to get us all there! Suitable premises, these vary from Small surgeries to
Patient presents with >8 on KC4 Repeat test on Coaguchek to confirm Check referral for Vitk sign off. BMS to consult patient for any potential reasons If patient is actively bleeding/bruising send to A/E If not, administer 2mg/0.2ml paediatric Vitk Arrange 24 hour Follow up with patient at ADAS Advise patient re bleeding/bruising Send episode report to Haematology Consultant
Search for all >8 INR’s from April 2012/2013 Filter into Clinics (Location) Filter into Reasons for <8 INR Demographics Has VITk been administered Follow up INR Exclusions 1.
2.
74 >8 INR’s found 5 Excluded due to Hospital “added history” 48 Clinic INR’s 21 Domiciliary INR’s
2 4 6 8 10 12 south shore fleetwood Bispham cleveleys lytham garstang
poulton thornton Kirkham
Clinic location
2 4 6 8 10 12 14 16 18 20 Drug interaction Alcohol No known reason Compliance Hospital overdose
Reason for <8
5 10 15 20 25 30 35 40 45 Drug interaction Alcohol No known reason Compliance Hospital overdose
reason by %
2 4 6 8 10 12 Antibiotics Gout medication Multiple new meds Chemotherapy Tramodol NSAIDS paracetomol
Drug by type
2 4 6 8 10 12 30-40 41-50 51-60 61-70 71-80 81-90
Age
Female, 23 Male, 21
Sex
45 patients were given Vitk in clinic 1 patient was admitted due to active bleeding. 1 patient was sent to A/E with headache and was found
1 patient was sent to Preston for Vitk. (Garstang
Range 1.5 - 6.6 Mean INR 3.3 Mean Target INR 2.8
8 5 7 Vitk Given admitted Omitted
Domiciliary treatment
2 4 6 8 10 12 Antibiotics No reason Given compliance Overdosed on initiation Unstable
Reasons for >8
45 Potential hospital admissions saved Estimated £119 - £219 per A/E visit = £5355 - £9855 Estimated £200 for overnight AMU up to £9000 Cost of a major bleed? Throw a dice in the air! PCC Average cost £640 Red cells £122.09 Platelets £208.09 Lets not forget the cost to the patient and family
We are actually pretty good at what we do?... 7 in 10,000 INR’s >8 We have the Vitk dose right, mean 24 hour INR 3.3 No complications with all 45 recipients Our initiation is safe More education needed re Drug changes Only 1 surgery actually refers patients starting ABX. Hospital dosing education More GP surgeries now stock Vitk