1. June Ward Haemophilia / Anticoagulant Nurse
Ward 34 day area
Ninewells Hospital

2. 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

3. 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

4. Reminders / Training for staff re Teachback methods, site visits by Phyllis & Angela
Adapting new patient checklist
Review new patient knowledge at 1st & 2nd visit
Patient focus groups

5. 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

6. 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 √

7. Results Question and expected answer Response rate comments
Why do you use warfarin
Expected: to keep my blood thin, prevent clots or stroke
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, , 3-4.5
8/12 (67%)
1 don’t know, 1 not valid range, others valid range
3. Duration
Expected: 3 mths , 6mths 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 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
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.

8. What next? Continue focus on teach-back methods within teams
Review education / patient knowledge at agreed time frames: 1st , 2nd 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