Inr 49 pge 12, 13, 14 singles

Durham & Darlington Foundation Trust

LEAD THE WAY IN INR HOME MONITORING THERE ARE APPROXIMATELY ONE AND A QUARTER MILLION PEOPLE IN THE UK WHO TAKE THE ANTICOAGULANT WARFARIN TO REDUCE THEIR RISK OF THE SERIOUS CONDITIONS SUCH AS DEEP VEIN THROMBOSIS, PULMONARY EMBOLISM, AND STROKE.

Warfarin can cause disruption to the patients life, from securing time away from work or other responsibilities to have their blood monitored at a clinic, the need to pay frequent car parking charges or bus fares and the inability to go away on holiday for anything resembling an extended period of time. Too often the patient is losing money and time – and overall quality of life. In that context, the success of a project which makes it possible for those on warfarin to be monitored from home is unsurprising.

Now patients cared for by County Durham and Darlington Foundation Trust have the option to use a digital self-monitoring service. They are trained to take a finger prick blood sample, put it onto a test strip, and then place the test strip in the monitor that is provided for them.

The monitor gives a reading of the person’s INR ( International Normalised Ratio), which is a measure of how quickly blood clots. They then give the result via an automated phone call.

Software automatically shares the figure with clinical staff, who check it, and the patient receives an automated call back letting them know whether they need to change their dose of warfarin.

That is all there is to it. No need to attend a clinic, and the patient can even choose the time of day at which they submit

12 InReview

their reading and at which they receive the call back with their dose. For the 200 people who have been on the service during its initial trial, the system has changed their lives.

It has also helped improve the patients’ outcomes. Before the project began, these people were only in therapeutic range around 60 per cent of the time. In other words, 40 per cent of the time their blood was either clotting too quickly, putting them at risk of thrombosis, or too slowly, putting them at risk of bleeding complications. By the end of the trial, time in therapeutic range had increased to around 75 percent, that is a significant benefit for the trust

SO WHAT IS HEALTHCALL INR MONITORING?

Mr C no longer has to risk his life during the winter to travel a 40 mile round trip down from the Durham Dales to our outpatients clinics

A collaboration between County Durham and Darlington Foundation Trust (CDDFT) and Inhealthcare to develop a diagnostic Health and social care platform for digital healthcare At arms length from CDDFT, an opportunity to work with new partners to develop new care services, Enabling self management, improving triage, health economy efficiency and access improvement Early areas of development INR, Nutrition

Mrs Dover was able to spend the last months with her mother and sister before they died in Manchester without worrying about having to travel home to clinic for INR testing

THIS INNOVATIVE PROJECT IS PROVIDING PATIENTS THE LIVES AND OUTCOMES THEY SEEK Reduces trips to clinic from an average of 18 per year to 1

THESE ARE REAL PATIENTS LEADING REAL LIVES Mr A works on Oil rigs in the North Sea and no longer has to fly back to Durham for his new Warfarin doses Mrs B is a Director in a large international company and no longer has to keep cancelling appointments due to work commitments

Although my experience of attending the hospital based clinic in Darlington Memorial Hospital was always good and well organised it always felt like an inconvenience to have to attend the clinic on a Tuesday or Friday morning.

Although my manager at work was supportive of my taking the time to go to the clinic it didn’t quite sit right with me that I needed to commit to attend. It also meant that I sometimes needed to decline meetings and delay pieces of work that I was expected to

complete within tight deadlines.

I’ve been self-testing for nearly 2 years now and have found it to be simple and a much more convenient process.

When I first heard that the trust was to pilot self-testing I thought it would only be available to patients that had difficulties getting to the clinic due to being in remote locations or were frail, elderly patients. When Tracey phoned me to see if I would like to take part in the pilot I jumped at the chance.

I attended a group session to talk through how

Saves patients on average £60 per year on travel and parking costs Patients can now receive their warfarin dose anywhere in the world using devices such as a phone, tablet or computer Time in Therapeutic Range (TTR) has improved on average of 16%, reducing the risks of thrombotic events Provides the opportunity of continuing to take warfarin without the need to take time off work to visit clinic

to do the testing and to get a demonstration of how it worked.

It was a bit daunting at first but once I’d self-tested 3-4 times I found it really simple. I was also surprised that I could choose the time of day that I would receive the telephone calls to take the result and dosing instructions as they didn’t need to be within the clinic times. I get the call to take my result at 7:45am which is much more convenient and doesn’t take up any of my work day which has improved my flexibility massively. The dosing call is 6:00pm so that too fits in

much more with my lifestyle. If I need to contact the clinic for any reason the staff are always friendly and helpful so I don’t feel like it’s affected my interaction and I certainly don’t feel isolated from advice.

All-in-all the whole service is excellent. Hearing from Ian that there may soon be a phone app shows that the trust is developing the service further and looking to make things simpler for patients; this is really encouraging.

InReview 13

IMPORTANTLY IT GIVES CLINICIANS REASSURANCE Designed by operational NHS nurses, ensuring safety was at the centre of the development Provides a digital audit trail of every detail of the interaction - NHS Health Call is also connected to the main dosing systems like 4S-DAWN By allowing 200 patients to self test, the patients who remain in clinic have more time with clinicians which also improved their TTR (+3%) Members of the team with two of their patients

Health Call is connected directly to GP records - Urgent Care and A&E clinicians have real-time updates on warfarin dose and INR result The system reduces the processing time for each dosing event by 85% - The average dosing time for a clinic patient is 3.75 minutes, whereas a self-testing patient is 0.5 minutes

IT IS A GREAT OPPORTUNITY FOR THE NHS NICE exemplar product Costs 16p per patient per day Offers a cost effective alternative to Novel Oral Anticoagulation drugs - Cost to move all Warfarin users to NOACs would be an additional ÂŁ772m If we achieved the 16% improvement of Warfarin patients at a national level this would equate to a 1500 per year reduction in Strokes Helps achieve the 5 Year Forward Plan in relation to supported self-care Roche now moved to a lease model moving away from the capital risk involved with CoaguCheks

Regarding my experience of self testing, I can say it has brought a positive and flexible approach to INR testing. Due to working full time and often travelling with work the possibility to self-test was extremely helpful.

In addition having the option to take the monitor away with me abroad is a great benefit so much so I would not like to find myself in a position where I had to travel without it.

Although I had nothing but positive experiences at the local warfarin clinic, I would find it very difficult now to revert back to testing at clinic rather than at home. I would also now feel confident to progress to self-managing.

14 InReview

SUMMARY PATIENT CENTRED: It is a simple and efficient solution that has taken away the need for patients to travel to clinic.

SAFE: Clinicians were involved in designing the system and processes.

INCREASED PATIENT SATISFACTION: Fewer trips to clinic mean less travel expenses and less disruption to daily life.

INCREASED CLINIC CAPACITY: Fewer patients unnecessarily attending clinics should create capacity for those more complex cases who require face-to-face care. At scale, this will help address the problem of INR clinics that are currently bursting at the seams.

IMPROVED OUTCOMES: Improved INR control means patients have a reduced chance of stroke or haemorrhage thus reducing the demand on acute services.

NHS HEALTHCALL:

www.nhshealthcall.co.uk How much does an anti-coagulation patient cost the NHS?