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Anticoagulation Therapy Services National Summit: News and Speaker updates

This summit focuses on delivering excellence in anticoagulation services. Through expert sessions and practical case studies the conference will look the components of an excellent anticoagulation service that are essential for delivering effectiveness, quality and patient safety.

The conference will open with a patient perspective on excellence in anticoagulation services, and continues with a clinical perspective from the authors of “Excellence in anticoagulant care” published in 2016. A key element of an excellent service is involvement of users and carers, the practicalities of which will be considered within the opening session.

Speaker updates and presentations

My Anticoagulation Journey: A Patient Perspective

Shaun Kinghorn Service Use

  • my anticoagulation journey
  • when things don’t go right
  • what does an excellent service look like?

Shaun Kinghorn Full Presentation Click Here

Shaun Kinghorn Presentation Abstract:

It is estimated that approximately 1.25 million patients in the U.K are being treated with oral anticoagulation1. This represents a major challenge to health care providers in trying to reconcile the therapeutic benefits of anticoagulation and ensure patient safety.

This presentation primarily focused on the experience of life on warfarin. Using personal experiences the presentation considered a selection of challenges associated with lifelong warfarin including the joys of surgery, invasive investigations, bridging and bleeding. 

Shaun Kinghorn Biography:

In June 2010, aged 49 Shaun was admitted to a medical emergency unit via A&E with severe breathlessness and intermittent confusion. Further investigations confirmed a diagnosis of an unprovoked bilateral pulmonary embolism with significant clot burden. This was the start of lifelong anticoagulation with warfarin. He remains under the care of two hospital consultants and INR monitoring is maintained by a hospital based pharmacy led anticoagulation service.

Shaun is semi-retired and works part time with the University of Sunderland designing online learning solutions for health care professionals. He qualified as a Registered Nurse in 1981. Prior to the Pulmonary Embolism he has worked within the third sector, academic institutions, and Department of Health designing and delivering online learning solutions for health care professionals.

In 2013 he decided to move into semi-retirement to focus on the things and people that matter most in his life and invest his best efforts into maintaining and improving personal wellbeing and fitness. Thankfully he has been able to resume his favourite hobbies of walking, fishing, and running.

Components of an excellent anticoagulation service

Helen Williams Consultant Pharmacist for CVD, Clinical Director for Atrial Fibrillation South London Health Innovation Network & Lead Quality Anticoagulation and AF Prevention Working Group

  • what are the key components of an excellent anticoagulation service?
  • demonstrating high quality
  • key recommendations and examples of good practice from the London Clinical Network

Helen Williams Full Presentation Click Here 

In her presentation Helen looked at Commissioning Excellence and dicussed 11 key areas: 

  1. Anticoagulant services should be offered in a convenient ‘one-stop’ clinic offering patient education, discussions, blood tests and drug / dose changes in the same consultation
  2. Anticoagulant services should be able to demonstrate that time from referral to assessment for treatment for people with AF is less than one week
  3. Anticoagulant pathways should offer people with AF access to all anticoagulant options in line with licensed indications
  4. Anticoagulant services should offer appropriate patients the opportunity to self-monitor or self-manage their vitamin k antagonist
  5. Anticoagulant services should ensure that all patients are issued and advised to carry an anticoagulant alert card, regardless of drug choice.
  6. Anticoagulation services should communicate to both the patient and their GP individual patient International Normalized Ratio (INR), to ensure safe prescribing, and time in therapeutic range (TTR), to inform discussions about ongoing management.
  7. Anticoagulation pathways should clearly define follow-up arrangements for all patients on anticoagulant therapy either within the anticoagulant services or via primary care.
  8. Anticoagulant pathways should be able to demonstrate how patients newly initiated on anticoagulant therapy are formally referred into the community pharmacy New Medicine Service for adherence support, where appropriate.
  9. Anticoagulant pathways should be able to demonstrate how they can provide for patients with complex needs
  10. Feedback from patients and carers should be sought and used to improve the local anticoagulant pathway
  11.  Local anticoagulant services should be able to provide data on:
    1. Service delivery - such as number of patients seen, number of patients self-monitoring and self-managing warfarin anticoagulation
    2. Quality and safety - such as time to first available appointment from referral
    3. Patient satisfaction and patient experience surveys

Involving and empowering patients in self monitoring

Prof Beverley Hunt Professor of Thrombosis & Haemostasis King’s College Founder and Medical Director Thrombosis UK

  • learning through personal journeys of anticoagulation therapy
  • self monitoring: the impact on quality of life
  • involving patients as partners: key issues and tips for success

Professor Beverley Hunt Full Presentation Click Here

In her presentation Professor Hunt disucces self monitoring for patients in anticoagulation​ services: 

"Warfarin? it’s a great drug and has been around for a long time – but it has its pros and cons"

“Warfarin is the major cause of drug error/ iatrogenic admission in the UK. Although alternatives cause problems too”

Why Self Monitoring?

Patient self-care is a key initiative in the NHS Plan for a patient centred health service and an important component in supporting people with long-term conditions. It is seen to provide:

  • Better symptom management
  • Improved feeling of wellbeing
  • Increase in life expectancy
  • Improvement in quality of life with greater independence

“It is much better if patients are able to take control of there care – when patients take charge they feel more empowered and in control of there life”

Self-monitoring may be a suitable option for a variety of people who are on long term anticoagulation therapy and want the convenience of being able to monitor their own INR levels at a time and place of their own choosing (e.g. if travelling abroad either with work or on vacation). They do have continuous support from their healthcare professionals and there are no upper age limits for self-monitoring and parents can take charge for their children.

Self-monitoring is ideal if:

  • People want a larger role in managing their condition and treatment
  • Committed to learning how to self-monitor
  • Would get full support from healthcare professionals
  • Find frequent hospital visits for an INR test inconvenient and disruptive

“Self monitoring is safe and has various studies to prove this”

“Patients who self monitor have a better life expectancy”

“Discuss dealing with health professionals when patient knows more about the illness - Patients need to be empowered about there conditions and to give them the confidence to speak with clinicians about what is happening to them”

“Discuss self monitoring if they wish (not always suitable for APS patients)”

“The NICE Quality Standards for Atrial Fibrillation Statement 6 (developmental) sates Adults with atrial fibrillation on long‑term vitamin K antagonist therapy are supported to self‑manage with a coagulometer. This means that every anticoagulation service in the UK should provide this opportunity to patients”

Professor Beverley Hunt Biography:

Professor Beverley Hunt is Professor of Thrombosis & Haemostasis at King’s College London and is a Consultant in the Departments of Haematology, Pathology and Rheumatology at Guy’s & St Thomas NHS Foundation Trust.

She has a large clinical practice, specialising in thrombosis and haemostasis, especially in inherited and acquired thrombophilias, obstetric haematology and acquired bleeding disorders. She is also Clinical Lead in Haematological Sciences within Viapath, a Pathology company (2/3 NHS owned) and sits on the operational board.

She is a national and international expert in thrombosis and acquired bleeding disorders. In England, she sits on the National VTE (venous thromboembolism) board & advises the Welsh Government

She runs a research group with over 280 peer-reviewed publications to her name, and won the BMJ Research paper of the year 2011 with the CRASH-2 team.  .

Her  Thrombosis committee have produced a free award-winning, downloadable iphone app containing a multitude of thrombosis guidelines in elegant algorithms:

http://itunes.apple.com/gb/app/thrombosis-guidelines/id448736238?mt=8

She is a Co-Founder and Medical Director of the thrombosis charity, ‘Lifeblood: the thrombosis charity’, now Thrombosis UK which was Health Charity of the Year 2010. She also is part of a global team organising the global “World Thrombosis Day”

Future events of interest:

Demonstrating & Improving Prescribing Competence & Practice: Implementing the New National competency framework for all prescribers
Friday 19 May 2017
De Vere West One Conference Centre, London

Non Medical Prescribing in Cardiology
Monday 18 September 2017
De Vere West One Conference Centre, London


28 April 2017

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