Journal of Pharmacy Management - Jan 2022

Journal of Pharmacy Management • Volume 38 • Issue 1 • January 2022 BEST PRACTICE IN PHARMACY MANAGEMENT Transformation of a Pharmacist-led Anticoagulation Clinic Service during COVID-19 Pandemic Karen Y Lee and Beejal Shah, Lead Pharmacists Surgery and Pain (job share), Richard Adama-Acquah, Clinical Pharmacist, Surgery. Royal Brompton and Harefield Hospitals (part of Guy’s and St Thomas’ NHS Foundation Trust), Sydney Street, London SW3 6NP Correspondence to: [email protected] Introduction The anticoagulation clinic is an established outpatient service managing patients on vitamin K antagonists (VKA) at the Royal Brompton and Harefield Hospitals (RBHH). In February 2020, the service was incorporated into the Pharmacy Team and evolved into a pharmacist-led anticoagulation service. The clinic has patients across two sites (Royal Brompton and Harefield Hospital) and is run as a traditional ‘test and post’ service where, following a venous INR sample, patients subsequently receive dosing advice either by post or telephone. The vision was to continue to develop a patient-centred approach using amulti-disciplinary team, with emphasis onmedicines optimisation initiatives. 1 This new pathway was developed by training a pool of pharmacists who completed competency-based assessments within a Trust approved Protocol. We were also able to deliver continuous specialist pharmacist input which allowed us to respond rapidly to the COVID-19 pandemic and to the needs of our patients. During the COVID-19 pandemic, the UK Government issued guidance for elderly and clinically vulnerable patients to shield and limit exposure to public places wherever possible. 2 Due to this, coupled with the reluctance of patients wanting to attend a hospital clinic, we rapidly implemented several initiatives to maintain patient safety and reduce patient footfall to the hospital. 3 Following a thorough internal risk assessment process, risks to both staff and patients attending the anticoagulation clinics operating under the clinic procedures were identified. The face- to-face hospital outpatient appointments significantly reduced and moved over to telephone and virtual clinics so we could continue to provide advice to patients during these unprecedented times. This transformation project involved identifying several strategies to achieve a reduction in patient footfall; these included switching suitable patients to direct oral anticoagulants (DOACs) where appropriate, working together with GP’s and primary care services to facilitate local INR testing and enrolling more patients onto the self-testing INR scheme. This project formed part of an ongoing wider Trust COVID-19 risk management strategy. Public health organisations recognised the complexity of the challenges faced by anticoagulation clinics nationwide, and subsequently issued national guidance to facilitate such projects which helped support this transformation. 4 Key words DOAC - Direct Oral Anticoagulant TIR - Time In Range VKA - Vitamin K Antagonist Methodology Baseline service: Pre COVID-19, the anticoagulation clinic service ran across two hospital sites as an outpatient clinic on set days of the week: Monday, Wednesday (one site 5