Dr Graham Parker M'B'B'S' D'R'C'O'G'

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Dr Graham ParkerM.B.B.S. D.R.C.O.G.

• Clinical Lead in Anticoagulation Monitoring
• for
• Marsh Medical Practice
• North Somercotes
• Lincolnshire

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• Delivering
• Anticoagulation monitoring
• With a little
• Nous

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• DAWN

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MMP Practice Profile

• Four fulltime Partners
• Five Nurses who provide 2.5 wte
• Population 6300
• Two sites 8 miles apart
• Practice Area 400 square miles
• Dispense to 95 of the patients

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Age Distribution
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Why we set up our ownAnticoagulation Monitoring
Clinic

• There was no named clinician responsible for
  dosing
• Not clear if primary or secondary care were
  monitoring patients
• Difficulties with telephone dosing
• No audit as to whether individual patients were
  satisfactorily anticoagulated
• Funding was available

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MMP Anticoagulation Team

• Lead Clinician and Nurse
• Deputy Clinician and Nurse
• Administrator

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Tools of The Trade

• CoaguChek XS Plus
• EMIS but moving on to System one
• DAWN
• Back up System

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Clinic Workload(18/4/2005 20/3/2006 )

• Anticoagulated population approx. 80
• North Somercotes 49 Monday Clinics
• Manby 41 Wednesday Clinics
• Total consultations 753
• Average consultations per clinic 8
• Fifteen minute appointments
• New patients seen by clinical lead first
• Annual review by clinical lead

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Average INR in RangeMMP v Benchmark01/11/05
to 30/04/06
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Time in RangeMMP v Benchmark01/11/05 to
30/04/06
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Atrial Fibrillation

• Population gt65yrs 1395
• Estimated prevalence of AF 2-5
• Estimated number in AF 23 70
• Actual number over 65 yrs 50
• Number anticoagulated 28

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Same Dose Daily
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Same Dose Daily

• No pharmacological reason for anything but same
  dose each day
• Why add another variable?
• National Patient Safety Agency report that
  patient want same dose each day

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Average Daily Warfarin Dose
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Increase in Weekly Dosewith a daily increase
of 500 mcgms
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0.5mg and 1.0mg Warfarin Tablets
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Advantages in using 1mg and 500mcgm Tablets

• Less confusion for patients
• Easy to communicate changes of dose
• Reduction in risk of overdose
• Decrease risk in dispensary

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The Future

• Happy, Informed, well anticoagulated patients
• Atrial Fibrillation register
• Self Monitoring
• Seamless transition between secondary and primary
  care
• Networking DAWN with other clinics in order to
  provide a team integrated approach to
  anticoagulation