1. Warfarin Management South Seas Healthcare Trust Safety in Practice March 2015

2. Our Clinic Project Team Safety in Practice Team members : Dr Andrew Chan Mow (Clinical Lead) Alesano Onasai (Practice Nurse) Solo Seiuli-Aiono (Practice Manager) (and the wider practice team) PHO support staff : Philippa & Vanita

3. WARFARIN MANAGEMENT GOAL Safety in Practice Compliant patients taking right warfarin dose provided by nurses, according to guidelines, with regular team reviews “excuse me, I wonder if I might give the warfarin another try?”

4. PDSA Improvement Measures Safety in Practice

5. ACHIEVEMENTS TO DATE Change Established 1 Practice wide usage of only 1 mg tablets 2 In transition from two systems to one. 3 Move from paper based process to electronic 4 Transition to nurse prescribing 5 Implementation of memory Angle (trial) 6 Implement documented policy for new staff 7 Evaluation of the Memory angle support tool 8 Consumer feedback survey to evaluate effectiveness of process from consumer perspective.

6. Reflection on current practice by the clinical team Up skilling opportunities for nurses GPS feel more confidence in safety in prescribing dosaging based on online BPAC guidelines Better compliance by patients with the 1mg only usage HIGHLIGHTS & IMPROVEMENT AREAS Identification of near misses Confidence across all staff in use of tool Focus on one area has resulted in slip in another

7. Where we started from To here so far.. This is the end of the presentation but not the end of the quality improvement journey

8. Safety in Practice NEW PROCESSES Smart Phone App for Warfarin Patients Memory Angel is a service to help carer's support people who need care

9. Safety in Practice SUSTAINABILITY ACTIONS Robustness of system System is simple to manage and intuitive Include warfarin management in orientation to new staff Develop policy document to include in orientation program for all new staff Annual audits using warfarin audit bundle (two consecutive months) prior to education updates Annual training update for all current staff and new staff on the warfarin management program and any actions required in areas identified in recent audit