2. NEAR PATIENT TESTING, DAWN UPGRADE AND INTO THE COMMUNITY IN THREE MONTHS NEAR PATIENT TESTING, DAWN UPGRADE AND INTO THE COMMUNITY IN THREE MONTHS Barts and The London NHS Trust

3. HOW A LARGE NUMBER OF CHANGES BECOME RELATIVELY PAINLESS WITH PREPARATION, SUPPORTIVE GUIDANCE AND BACKING HOW A LARGE NUMBER OF CHANGES BECOME RELATIVELY PAINLESS WITH PREPARATION, SUPPORTIVE GUIDANCE AND BACKING Aim to show:

4. BACKGROUND THE TEAM CONSULTANT HAEMATOLOGIST TWO A/C NURSE PRACTITIONERS ONE A/C PHARMACIST PRACTITIONER THREE JUNIOR PHARMACIST PRACTITIONERS ONE ANTICOAGULATION ADMINISTRATOR TWO JUNIOR ADMINISTRATORS  Across three sites and a GP surgery  7 clinics each week; 5 team attended, 2 phlebotomy only

5. Classic trip to clinic; 1-1.5hrs

6. PATIENT CENTRED AUDIT POSITIVE ATTENTION, ATTITUDES AND FUNDING HOW A LARGE NUMBER OF CHANGES……. NEAR PATIENT TESTING DAWN UPGRADE AND NETWORKING COMMUNITY MONITORING

7. PATIENT CENTRED AUDIT : Identification of key areas of service development 1.Patients views of the standard of service provided to two of the sites. Evaluated using self completed structured questionnaire devised as part of research project by pharmacist; prolonged and unpredictable waiting times in clinic 2. Utilisation of clinic areas Evaluated using localised risk assessment ; overcrowding, practical difficulties of seating and ill equipped consulting rooms 3.Patient transport into clinics; Evaluated using daily recording of complaints and problems, discussions with transport department and many individual patients opinions from the patient forum ; transport patients attending together adding to the overcrowding and prolonged waiting. Lack of transport entirely on many occasions

8. Key areas to address Waiting times for staff and patients Overcrowding and poorly equipped clinic areas Hospital transport difficulties Risk around transportation of samples Laboratory workload and target pressures as well as recruitment and retention issues Phlebotomy extreme recruitment, training and retention issues Efficient use of teams time and resources available Near Patient Testing Better use of DAWN Community monitoring

9. POSITIVE ATTENTION, ATTITUDES AND FUNDING HOW A LARGE NUMBER OF CHANGES BECOME RELATIVELY PAINLESS WITH PREPARATION, SUPPORTIVE GUIDANCE ………………... To patients individually and as a group, team, associated staff, general mangers (2) Team meetings, clarification of aims and objectives Business plans Pinpointing all but only relevant information Guidance in writing of plans clearly and briefly Understanding of who presenting to How ? Email, Letter, Telephone or In person

10. HOW A LARGE NUMBER OF CHANGES BECOME RELATIVELY PAINLESS WITH PREPARATION, SUPPORTIVE GUIDANCE …AND…BACKING! SHOW ME THE MONEY!!! Funding for research pilot to compare to methods of testing in the community PCT and GP involvement; bid accepted for future plan for primary sector based care Government patient choice initiative; money to change clinics now for the good of the patients QUICKLY OR THE MONEY HAS GONE!

11. Near Patient Testing Comparisons of other clinics the models already used Literature reviews of clinic styles and comparisons of portable coagulometers Own clinic based comparison of two portable coagulometers (just under 1% annual INRs compared with venous results) Decision on coagulometer to use Development of QC and Neqas protocols Development of Standard Operating Procedure in collaboration with the lab Education of team, patients and phlebotomists Pilot in small clinic Collation of experiences and feedback; replan Introduction into clinics ; September 2003

12. DAWN Upgrade Finally after 4 years of using system (version 4.61) all patients entered on DAWN IT, management and team agreement in formulation of plan for soft and hard ware needed Software came (thank you 4S)…hardware didn’t!! Training of team in new system Installing, upgrading and applying across a server; October 2003

13. Community Monitoring Exploring alternatives for home testing Support from patients and team to identify optimal model of care Research pilot plan for comparison study; patient and staff recruitment Randomisation of the patients Community monitoring launched; November 2003

14. Conclusion HOW A LARGE NUMBER OF CHANGES BECOME RELATIVELY PAINLESS WITH PREPARATION, SUPPORTIVE GUIDANCE AND BACKING NPTSeptember 2003 DAWN upgrade and networkingOctober 2003 Community monitoringNovember 2003