June Ward Haemophilia Anticoagulant Nurse Ward 34 day
- Slides: 8
June Ward Haemophilia / Anticoagulant Nurse Ward 34 day area Ninewells Hospital juneward@nhs. net
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 1 st & 2 nd 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 (100%) 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 , 6 mths 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.
What next? • Continue focus on teach-back methods within teams • Review education / patient knowledge at agreed time frames: 1 st , 2 nd 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