Journal of Pharmacy Management - Jan 2022

Journal of Pharmacy Management • Volume 38 • Issue 1 • January 2022 boundaries in the future. There was variability in the uptake of local INRmonitoring between both sites; this was mainly due to patients expressing preference to have INR checks in hospital and patients living in closer proximity to one of the hospital sites as opposed to the GP surgery. INR self-testing scheme - Due to the self-testing initiative, we increased the proportion of patients on the self-testing programme from a baseline of 17% to 47% across the Trust. The most significant impact of this process resulted in patients feeling empowered to independently assess their anticoagulant therapy, whilst enabling a greater degree of flexibility and autonomy in the management of their own care. This sustainable method of INR testing is something which can continue post pandemic. 5 It was a challenge to teach and train patients without a face-to-face clinic, but the virtual platform helped to give our patients assurance of a 1:1 consultation, whilst being able to review their technique virtually and identify any problems if needed and maintain effective communication. The use of virtual clinics can be further developed and embedded into our practice. We experienced several patients who were able to demonstrate competence under supervision at the 1-1 virtual consultation but later required further support. This highlighted the need for ongoing training and tailoring this to meet the individual needs of our patients. Work is ongoing to develop a series of pre- recorded instructional videos for use alongside the manufacturer’s instructions which will help to enhance the quality of training and ensure patients feel supported during the initial stages of transferring to the programme. We encountered a small number of patients who rated highly in our triaging tool but later became reluctant to self-test their INR and on balance were happy to maintain their outpatient clinic appointments. The safety of patients during the pandemic, their risk factors and shielding expectations were our prime concern. However, through undertaking this project, patient consent and their preference on how to safely manage their INR test results remained the ultimate choice of the patient. The next step in our INR self-testing initiative will be to gain feedback of our patients’ experience and perceived benefits or challenges to self-testing, as well as seeking to improve the delivery of a newer and more responsive anticoagulation service to meet the needs of our patients. Analysis of percentage TIR reveals that there is no significance difference between patients’ INRmanagement before and after the 3main strategies were employed during the pandemic. These data were for a short period to gain an overview for the safe anticoagulation management following our interventions, however a repeat review of these parameters will be conducted again with 1-year comparable data to capture all patients and allow new initiatives to be embedded in the clinic. Impact of DOAC switches – Switching 26% of appropriate patients to DOACs has resulted in a reduction in the number of patients in the RBHH VKA clinic. However, by undertaking this initiative, we recognise there is scope to increase the diversity of the current clinic by reinvesting resources to set up new services such as DOAC monitoring/initiation clinics alongside VKA clinics. Using our specialist anticoagulation knowledge in tertiary care, building on the initiatives we have implemented, coupled with the links built with primary care, our vision is to establish a patient-centred innovative anticoagulation service across primary and secondary care. This service would aim to bring together primary and secondary care to support our patients and clinicians to safely deliver an all-encompassing anticoagulation service. There were lessons learnt and limitations that continued to challenge us during this project. These included: • Time taken to undertake the 3-step consent process during the DOAC switches and waiting to hear back from different MDT members, so patients still had to attend hospital INR clinic appointments. • Ensuring timely communication with MDT during and after the change of anticoagulation therapy. During the pandemic there was a lack of easy access with GP through phones or emails. With current technology, secondary care were unable to access the primary care spine, create nominated pharmacy prescriptions or update patient medical records. • Challenges faced in the anticoagulation clinic to co- ordinate INR results from the GP and give dosing advice to the patient. This was hugely dependent on receiving INR results from the GP in a timely manner. • Management of high INR results from GP’s was a challenge as results were often emailed out of hospital working hours. 10