Warfarin Management

South Seas Healthcare TrustSafety in Practice

March 2015

Our Clinic Project TeamSafety 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

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?”

PDSA Improvement Measures

Safety in Practice

Safety in Practice Safety in Practice

ACHIEVEMENTS TO DATE Change Established

1 Practice wide usage of only 1 mg tablets2 In transition from two systems to one.  3 Move from paper based process to electronic 4 Transition to nurse prescribing5 Implementation of memory Angle (trial)6 Implement documented policy for new staff7 Evaluation of the Memory angle support tool 8 Consumer feedback survey to evaluate

effectiveness of process from consumer perspective.

• 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

Where we started from

To here so far..

This is the end of the presentation but not the end of the quality

improvement journey

Safety in Practice 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

Safety in Practice 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