Overcoming Communication 1 0.5 Problems in the Anticoagulation - - PowerPoint PPT Presentation

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Overcoming Communication Problems in the Anticoagulation Service at CHFT

By Harry Crank Administrator

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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• 4600+ patients
• 2 x BMS (1 full-time & 1 part-time),

1 x Specialist Nurse, 1 x Administrator, 1 x MLA (part-time)

• Open Monday – Friday
• 30+ phlebotomy-led community clinics
• 110 GP’s
• Referrals from Ward, GP’s and other Hospitals

Brief overview of our Service

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Where are we?

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Area of where we cover…

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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History of our Service

1995 – Two different services on two sites

– CRH had an “In-house” system, all venous, no OPD service, dose and post – HRI had a Dr led, manual dosing fingerprick clinic

2002 – HRI site went on to Dawn v.6

– Interface bought but only unidirectional

2008 – CRH “In-house” system broke down

– CRH patients integrated on to HRI’s Dawn v.6 system

2009 – Both sites merged & relocated all at HRI 2010 – Upgraded to Dawn v.7 2012 – Bought a paper folding machine 2013 – Bought 4 CoaguChek Pro’s

Chairman: Andrew Haigh Chief Executive: Owen Williams

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What have we improved?

Patient dosage letters GP dosage letters Telephones District Nurses / Pharmacies letters Yellow Record Book Stickers

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Patient Dosage Letters

Old process involved:

• 1 x Yellow questionnaire /

blood test request form

• 1 x dosage letter
• 2 x sticky labels
• Hand-folded & Enveloped

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Patient Dosage Letters

New Process now:

• EconoMailer paper – dosage /

sticker / blood test request form / questionnaire all in one

• Machine folded – no need to

envelope

• Saved on paper & time

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

Old Method

• Print out
• Fold
• Sort
• Delivery to GP’s via

internal mail post-room

• Hospital -> GP about 3-

4 days turnaround

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

New process now goes electronic

• Sent via email -> GP portal
• Sent every night
• GP’s receive in morning
• 8 different types of letters are sent at the

moment

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

To ensure the Letters can be sent to the correct GP Surgery all the surgeries

• n the portal (80 in total)

are assigned a ‘Bxxxxx’ number, these were all inputted in the OrganisationCode along with the email address

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

All the GP’s who are on the ‘portal’ need to have the E-mail address assigned and the messaging method changed from Mail to E-mail

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

• The letters are sent from Dawn via email to a dedicated

email server – The Trust Integration Engine (TIE).

• To ensure the portal could pick out the patient details, the

DescriptionTemplate was changed to include the Letter Name (GPLxxx) : NHS No. : Hospital No. : GP Practice code : Patient Last Name : Patient First Name : D.O.B

• Letters are sent by the TIE every night at midnight. This

ensures any letters that have been amended during the day can be replaced with the newest version.

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

Letters sent electronically GP Dosage NPSA annual review Non-Attendance Discharge for Non-Attendance Non-Compliance End of Treatment Stop Referral Confirmation Transfer to Primary Care POCT

October 4234 November 4192 December 3482 January 4524 February 4212 March 4345 April 4670 May 4858 June 4542 July 4794 August 4436 TOTAL 48289

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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GP Dosage Letters

Old Process Printing, folding and sorting

• f 200+ GP letters ~ 2

hours/day Changed printer cartridges every 1 – 2 months Used lots of paper & envelopes GP received letters 3-4 days later New Process

All GP surgeries on ‘portal’ are sent everyday The out of area GP’s still print but only about 10 letters / day Printer cartridges last 4-5 months now 75% of GP surgeries receive their letters the following day More time to do other tasks A saving of ~ £800 / year

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Telephones

1 x Fax 1 x Telephone 1 x Fax 3 x Telephones (same number and 2 headsets) 1 x Scanner (to attach letters, referrals on to patient notes in Dawn) Past Present

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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District Nurse & Pharmacy Letters

Old Method

• Name and address were

added to the NOK contact details

• This would only allow one
• ther person to be

informed of the patients dose and next test

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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District Nurse & Pharmacy Letters

New Method

• All District Nurse teams and Pharmacies are now added as a

HCProfessional with their address and other details

• These can then be added to patients as a ‘contact’ so each time

they’re dosed, a NOK style letter prints out for the associated contact

• A district nurse, pharmacy and NOK can now receive letters –

improving the communication to other parties

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Yellow Record Book Stickers

• When going on to V.6, at the

same time we purchased a book printer but this was shortly discontinued as it was too problematic

• Staff resorted to hand writing

details in to new/replacement yellow books

• Labels were created when on v.7

to make it easier for completing yellow books

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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What Next? Future Plans…

• Email account
• Stop the use of internal faxing
• Redesign of patient request forms
• Telemedicine ?

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Any questions?

Chairman: Andrew Haigh Chief Executive: Owen Wilson

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Harry Crank (01484) 355014 harry.crank@cht.nhs.uk

Contact Details: