REDUCING DNAs WITH DAWNAC

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REDUCING DNAs WITHDAWN-AC

• John Seal
• Chief Biomedical Scientist
• Anticoagulation Service
• Mid Yorks Hospitals NHS Trust

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REDUCING DNAs WITHDAWN-AC

• How many DNAs does your clinic have?
• Pontefract had 210 per month
• About 8
• One DNA letter sent out immediately for each
  visit missed.
• Up to 5 identical letters sent

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REDUCING DNAs WITHDAWN-AC

• At Pinderfields situation very different
• Pinderfields had 412 DNAs per month
• About 14
• 4 DNA letters one for each week missed
• 1 GP letter
• DNA letters rarely sent out before week 3
• Up to 5 different letters sent out
• Very time consuming

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REDUCING DNAs WITHDAWN-AC

• Reviewed situation with Consultant
• Decided 5 weeks was too long to leave
• DAWN-AC set up a combination letter
• We created the text and indicated what should be
  said in each successive letter
• 1 DNA letter with variable text
• 1 letter to GP

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REDUCING DNAs WITHDAWN-AC

• DNA letter spread text over 3 weeks
• 3rd week letter warned last appointment
• We will write to GP
• In DAWN-AC one simple step
• Suspend patient
• Write to GP
• Check Hospital PAS before sending

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Mr S Stewart 74 Reghed Way Penrith Cumbria CA6
5JS   Unfortunately you missed your appointment
on 27/07/2006. A further appointment has been
made for you to attend Pontefract General
Infirmary on 03/08/2006 at 0930.   It is
extremely important that your INR blood test is
regularly checked whilst you are on Warfarin and
that you come to the clinic on the day that we
arrange for you. Please change the appointment
if it is inconvenient by ringing the
Helpline.   Could you or you representative
please inform us if there is any reason why you
cannot keep this new appointment, e.g. illness or
in hospital, by ringing the Anticoagulant Clinic
Helpline.   ANTICOAGULANT CLINIC HELPLINE 01977
606481   Yours sincerely   John
Seal Anticoagulant Clinic
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Mr S Stewart 74 Reghed Way Penrith Cumbria CA6
5JS   Unfortunately you missed your appointment
on 27/07/2006. A further appointment has been
made for you to attend Pontefract General
Infirmary on 03/08/2006 at 0930.   It is
extremely important that your INR blood test is
regularly checked whilst you are on Warfarin and
that you come to the clinic on the day that we
arrange for you. Please change the appointment
if it is inconvenient by ringing the
Helpline.   According to our records you have
missed two appointments It is in your own
interest to have your INR checked so that that we
can make sure you are on the correct dose of
Warfarin   Could you or you representative please
inform us if there is any reason why you cannot
keep this new appointment, e.g. illness or in
hospital, by ringing the Anticoagulant Clinic
Helpline.   ANTICOAGULANT CLINIC HELPLINE 01977
606481   Yours sincerely   John
Seal Anticoagulant Clinic
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Mr S Stewart 74 Reghed Way Penrith Cumbria CA6
5JS   Unfortunately you missed your appointment
on 27/07/2006. A further appointment has been
made for you to attend Pontefract General
Infirmary on 03/08/2006 at 0930.   It is
extremely important that your INR blood test is
regularly checked whilst you are on Warfarin and
that you come to the clinic on the day that we
arrange for you. There are substantial life
threatening complications such as thrombosis or
bleeding for patients, who like yourself are
taking Warfarin, if not well controlled. Please
change the appointment if it is inconvenient by
ringing the Helpline.   According to our records
you have now missed three appointments It is in
your own interest to have your INR checked so
that that we can make sure you are on the correct
dose of Warfarin. After this appointment we will
not be able to arrange any more appointments for
you until after we have consulted with your
GP.   If you fail to keep this appointment we
will no longer be able to safely dose you for
your Warfarin and we will be obliged to contact
your GP to request them not to prescribe you any
more Warfarin until your INR has been
checked   Could you or you representative please
inform us if there is any reason why you cannot
keep this new appointment, e.g. illness or in
hospital, by ringing the Anticoagulant Clinic
Helpline.   ANTICOAGULANT CLINIC HELPLINE 01977
606481   Yours sincerely   John
Seal Anticoagulant Clinic
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REDUCING DNAs WITHDAWN-AC

• How did this affect the numbers of DNAs for each
  clinic?
• An Audit of DNA numbers over 3 years
• Showed dramatic decrease in DNAs

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REDUCING DNAs WITHDAWN-AC
Start here
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REDUCING DNAs WITHDAWN-AC

• Reduced to 260 per month from 412
• Reduction of 37
• Now only 8 of patients instead of 14

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REDUCING DNAs WITHDAWN-AC

• Was there any effect on persistent non attenders?
• An Audit of patients who missed 3 consecutive
  weeks produced interesting results!

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REDUCING DNAs WITHDAWN-AC
Start here
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REDUCING DNAs WITHDAWN-AC

• July 2004 June 2005
• 231 patients missed 3 consecutive weeks
• July 2005 June 2006
• 82 patients missed 3 consecutive weeks
• A Reduction of 64

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REDUCING DNAs WITHDAWN-AC

• OVERALL RESULTS
• DNAs down by 37
• Persistent DNAs down by 64

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NATIONAL DNA SURVEY

• PLEASE HELP ME WITH THIS SURVEY.
• FILL IN A FORM AND TELL ME ABOUT YOUR SYSTEM