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Learning Session 3

PHO and Facilitator: Procare

Team members: Sandra Hewlett

Audrey Cassidy and Dr Cliff AhKit

Manukau City Accident and Medical Centre

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Name of Audit Tool

Aim: Warfarin Bundle

Briefly describe what you were trying to achieve in your practice

• Paperless system of INR Monitoring• Greater Compliance/stability of INR patients• Better Education re Warfarin to patients and

staff.

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Change IdeasDriver Diagram

Moving from a paper system to automated has

improved compliance and reduced time of Doctors as Nurses are now managing the entire process. Increase education to the patients.

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Change Package

Change Tested Outcome / Evidence of Improvement

1 Paperless system Most Inr results are sent my email. Recall system used to identify patients due on a daily basis. Compliance spreadsheet updated and checked daily.

2 Compliance Using Spreadsheet data has been able to identify non compliant patients earlier and work with them. Extended times between tests for compliant, stable patients.

3 Education Through education – better compliance and stability have been achieved allowing more time to educated non compliant unstable patients.

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PDSA Cycles

Which PDSA provided the most learning for your practice? Development of BEST PRACTICE

Which PDSA was the most succssful?

Development of Best Practice with the use of recall audit system and spreadsheets.

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Measures Summary

Briefly describe what you are measuring and how and why?

• We are measuring how successful the educational data is for our patients.

• How often patients are being tested• How compliant our patients are• Have our patients become more stable.• Have we been able to identify reasons for non

compliance.

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Measures Summary

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Achievements to dateDo you have an

-agreed aim – Paperless system – greater compliance/stability

-a change package – Best Practice

-measurement plan – Using spreadsheet we can quickly identify patients missing tests.

Do people on your team know what their responsibilities are and what is expected of them? YES

What has changed and what difference have the changes made?

Less time spent on INR Management

Few Patients on Warfarin

Better Educated patients

Greater Compliance/stability

Fewer INR test by stable patients.

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Trigger Tool / Climate Survey

Please provide a summary of your experience of using either the trigger tool or the climate survey and subsequent actions taken following the use of either of these tools

We have noticed that patients who are beginning to deteriorate from other causes show INR instability earlier than some other systems.

When usually stable patients have an INR reading our of the ordinary we call them, discuss possible causes and seek assistance from their core team.

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Any other achievements?

Add any thing else you’d like to share here:-How the work has impacted your team-Anything else you think might be useful to share

1.This has given the Nursing staff greater confidence to begin other Nurse lead projects in the practice.

2.Leads the practice to a paper free work environment

3.Nurses have taken on the task to relieve doctors for compliance due to time restraints.

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Highlights and Lowlights

- What has been the experience of the team (General Practitioners, nursing and administrative staff and patients) in terms of their involvement in the improvements that have been made

- Less time spent on INR management.- Better patient contact and understanding- More confidence in moving to paper free

systems in the practice.