The Anticoagulation Service at Salisbury District Hospital

1. The Anticoagulation Service at Salisbury District Hospital Nic McQuaid And Rachel Woodford Anticoagulation Nurse Practitioners

2. Areas of Service • Outpatient anticoagulation dosing • Inpatient anticoagulation dosing • New patient clinics • Outpatient DVT service • Nurse led thrombophilia service

3. Outpatient dosing • 2419 active patients • Currently using DAWN (decision supporting software) • Postal dosing service • Near patient testing • Telephone consultations • Close contact with local GP surgeries

4. Inpatient dosing • Dosing and monitoring as per patient need • Average 15-20 inpatients in hospital at one time • Available for general advice for nursing and medical staff. • Discharge counselling service • Plans for further education in this area

5. New patient clinics • GP and outpatient referrals • Patients seen usually within one week • 30 minute slot with nurse to discuss and initiate treatment • Patient provided with standard NPSA documentation (the yellow pack)

6. Outpatient DVT service • Referrals originate from GPs, outpatient clinics, AMU and ED • Seen in vascular department for scanning • If necessary patient referred to pathology for routine blood samples • Patient assessed on AMU and decision for anticoagulation made

7. Outpatient DVT service • AMU contact us for appointment • We aim to see patients same day or following • Patient given • Advice on and initiation of warfarin • Education on Dalteparin administration • Organise community/practice nurses if necessary • Advice on leg care and compression hosiery • Ongoing support throughout length of treatment • Letter sent to GP • All patient data entered into VTE database, which allows prospective data capture. • Referrals made into thrombophilia clinic if necessary.

8. Nurse led thrombophilia clinic • Developed in demand to waiting list breaches and to decrease consultant workload • Extension made to current in house VTE database • Patient seen by nurse, full personal and family thrombosis history taken and entered onto database • Thrombophilia screen performed if necessary and within recent guidelines • Patient given personal, standardised advice on positive interventions to reduce risk of further VTE.

9. Nurse led thrombophilia clinic • Electronic summary printed from database • Majority of referrals closed by the nurse • If patient needs medical advice referred into the monthly consultant clinic. • Letter generated from database sent to patient, GP and copy into patients notes • Decreased waiting times from average 10 weeks to 5, decreased consultant workload around 3 hours a month.