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Experiences of Benchmarking and the effect of new patients

Experiences of Benchmarking and the effect of new patients. Mrs Dorothy Shaw Chief BMS Stepping Hill Hospital Stockport. STEPPING HILL HOSPITAL. District general hospital near Manchester 815 Beds Excluding Mental Health And Maternity. Anticoagulant Service Run by Haematology.

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Experiences of Benchmarking and the effect of new patients

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  1. Experiences of Benchmarking and the effect of new patients Mrs Dorothy Shaw Chief BMS Stepping Hill Hospital Stockport

  2. STEPPING HILL HOSPITAL • District general hospital near Manchester 815 Beds Excluding Mental Health And Maternity

  3. Anticoagulant Service Run by Haematology • BMS Staff • Chief • Senior • Total of 5 BMS Staff who can dose at clinics • 2 Part time MLA staff • 3 Hospital Clinics + 10 Outreach clinics • 2670 active patients on DAWN Oct 2002

  4. DAWN System Purchased Jan1999Joined Benchmarking At Same Time Before DAWN Audit of stable patients 60% INRs in Range

  5. Decision to put all available information onto dawn to aid dosing including a) New patients AFs started in hospital outpatient clinic baseline INR, 9 mg on 2 days test 3rd day All patients loaded in hospital, inpatient dosage by hospital doctors, discharge dosage by laboratory Transfers from other hospitals b) Existing patients Dosage information from hospital stay

  6. BENCHMARKING • Monitoring of performance • site - site comparison • BSH guidelines • internal audit

  7. OUTSIDE INFLUENCES • Afs started in hospital clinic baseline INR and loading doses recorded onto comments • Start with INR on 3rd day • record inpatient doses onto comments • record information from transfers onto comments

  8. RESULTING IN • Information on DAWN related only to inrs and dosages done in anticoagulant clinic

  9. Comparison for new patients weeks therapy 1 -3 • April 2001 April 2002 • no of pts 398 361 • no of INRs 2018 832 • % time in range 40.28 52.13 • % INRs in range 35.23 51.42 • % INRs below range 47.25 29.30 • % INRs > 5 3.62 2.72 • % INRs <1.3 17.92 2.10

  10. CONCLUSIONS • Monitoring of clinic performance • Hospital and outreach clinics • disregard other influences • improve performance in appropriate INR ranges • Internal audit - Inpatient dosing audit • Dawn is working well in the clinic

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