1. Overcoming the Challenges & Promoting Positive Benefits Julie Davies

2. AIM To enable Practices in Wales to review their prescribing of oral anticoagulation and to assess the extent to which they comply with the guidance issued by the National Patient Safety Agency (NSPA, 2008) National Patient Safety Agency (2008) Patient Safety Alert 18-Actions that can make anticoagulant therapy safer. NSPA, London.

3. FACTS Anticoagulants are widely used. About 1% of a practice population are on anticoagulants at any time. Anticoagulants are associated with a significant number of adverse drug events, hospital admissions and death (NPSA, 2008) National Patient Safety Agency (2008) Patient Safety Alert 18- Actions that can make anticoagulant therapy safer. NPSA, London.

4. The Primary Care Quality and Information Service (PCQIS, 2010 updated)have developed an audit toolkit to address processes which could be implemented to improve patient care. The Primary Care Quality and Information Service (PQIS) (2010) Anticoagulation (warfarin) Quality improvement toolkit. PCQIS, Public Health Wales, Wales.

5. The audit toolkit provides the user with a summary of the evidence directing the safe use of anticoagulation medication, the organisational components stipulated in the nGMS contract (BMA, 2003) and a schedule of patient review criteria to compare current treatment against evidence based criteria. British Medical Association (BMA) (2003) GMS contract. National Enhanced service Anticoagulation monitoring: supplementary document. BMA, London.

6. REVIEW AREAS Indication for anticoagulation Screening Investigations Anticoagulant drug dosage Alternative appropriate therapy Anticoagulation control Management plans Follow up Patient held records

7. CHALLENGES Coding issues Fragmentation of information IT Time & resources Communication

8. POSITIVE OUTCOMES Development and implementation of an anticoagulant template to address key issues Feedback to GP’s and other relevant practice members Designation of a person to check that correct coding is taking place

9. POSITIVE OUTCOMES (cont) Spread sheet with all the relevant information in one place Professional Development Job satisfaction Benefits when re-auditing

10. Thank you for listening