Overcoming Communication 1 0.5 Problems in the Anticoagulation Service at CHFT By Harry Crank Administrator 3 5
Brief overview of our Service • 4600+ patients • 2 x BMS (1 full-time & 1 part-time), 1 x Specialist Nurse, 1 x Administrator, 1 x MLA (part-time) • Open Monday – Friday • 30+ phlebotomy-led community clinics • 110 GP’s • Referrals from Ward, GP’s and other Hospitals 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
History of our Service 1995 – Two different services on two sites – CRH had an “In-house” system, all venous, no OPD service, dose and post – HRI had a Dr led, manual dosing fingerprick clinic 2002 – HRI site went on to Dawn v.6 – Interface bought but only unidirectional 2008 – CRH “In-house” system broke down – CRH patients integrated on to HRI’s Dawn v.6 system 2009 – Both sites merged & relocated all at HRI 2010 – Upgraded to Dawn v.7 2012 – Bought a paper folding machine 2013 – Bought 4 CoaguChek Pro’s 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
What have we improved? � Patient dosage letters � GP dosage letters � Telephones � District Nurses / Pharmacies letters � Yellow Record Book Stickers 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Williams
Patient Dosage Letters Old process involved: • 1 x Yellow questionnaire / blood test request form • 1 x dosage letter • 2 x sticky labels • Hand-folded & Enveloped 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
Patient Dosage Letters New Process now: • EconoMailer paper – dosage / sticker / blood test request form / questionnaire all in one • Machine folded – no need to envelope • Saved on paper & time 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters Old Method • Print out • Fold • Sort • Delivery to GP’s via internal mail post-room • Hospital -> GP about 3- 4 days turnaround 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters New process now goes electronic • Sent via email -> GP portal • Sent every night • GP’s receive in morning • 8 different types of letters are sent at the moment 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters To ensure the Letters can be sent to the correct GP Surgery all the surgeries on the portal (80 in total) are assigned a ‘Bxxxxx’ number, these were all inputted in the OrganisationCode along with the email address 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters All the GP’s who are on the ‘portal’ need to have the E-mail address assigned and the messaging method changed from Mail to E-mail 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters • The letters are sent from Dawn via email to a dedicated email server – The Trust Integration Engine (TIE). • To ensure the portal could pick out the patient details, the DescriptionTemplate was changed to include the Letter Name (GPLxxx) : NHS No. : Hospital No. : GP Practice code : Patient Last Name : Patient First Name : D.O.B • Letters are sent by the TIE every night at midnight. This ensures any letters that have been amended during the day can be replaced with the newest version. 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters October 4234 Letters sent electronically November 4192 � GP Dosage December 3482 � NPSA annual review January 4524 � Non-Attendance February 4212 � Discharge for Non-Attendance March 4345 April 4670 � Non-Compliance May 4858 � End of Treatment Stop June 4542 � Referral Confirmation July 4794 � Transfer to Primary Care POCT August 4436 TOTAL 48289 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
GP Dosage Letters Old Process New Process Printing, folding and sorting All GP surgeries on ‘portal’ are sent everyday of 200+ GP letters ~ 2 hours/day The out of area GP’s still print but only about 10 letters / day Changed printer cartridges Printer cartridges last 4-5 every 1 – 2 months months now Used lots of paper & 75% of GP surgeries receive envelopes their letters the following day GP received letters 3-4 days More time to do other tasks later A saving of ~ £800 / year 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
Telephones Past Present 1 x Fax 1 x Fax 1 x Telephone 3 x Telephones (same number and 2 headsets) 1 x Scanner (to attach letters, referrals on to patient notes in Dawn) 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
District Nurse & Pharmacy Letters Old Method • Name and address were added to the NOK contact details • This would only allow one other person to be informed of the patients dose and next test 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
District Nurse & Pharmacy Letters New Method All District Nurse teams and Pharmacies are now added as a • HCProfessional with their address and other details These can then be added to patients as a ‘contact’ so each time • they’re dosed, a NOK style letter prints out for the associated contact A district nurse, pharmacy and NOK can now receive letters – • improving the communication to other parties 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
Yellow Record Book Stickers • When going on to V.6, at the same time we purchased a book printer but this was shortly discontinued as it was too problematic • Staff resorted to hand writing details in to new/replacement yellow books • Labels were created when on v.7 to make it easier for completing yellow books 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
What Next? Future Plans… • Email account • Stop the use of internal faxing • Redesign of patient request forms • Telemedicine ? 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
Any questions? 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
Contact Details: Harry Crank (01484) 355014 harry.crank@cht.nhs.uk 1 3 5 Chairman: Andrew Haigh 0.5 Chief Executive: Owen Wilson
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