The Glasgow Anticoagulation Service (GAS) was established in 2002.  There is a multi-disciplinary team of staff consisting of nursing, medical, pharmacy, BMS and clerical staff who manage a team of 8,800 + patients throughout the Greater Glasgow & Clyde Heath Board area. The service provides 45 outreach clinics, 16 hospital clinics and 27 domiciliary sessions weekly.

A reorganisation of the service in 2006 lead to a city-wide approach to warfarin management.

The service offers one-stop clinics for patients. Capillary testing of blood and INR results are provided using KC1 Deltas at clinics and Coaguchek S machines at the Domicilary visit sessions.  Dosing is done with DAWN AC and manual dosing is done using standardised manual dosing charts.

In response to the National Patient Safety Agency Safety Alert 18, multi-disciplinary meetings and sub group meetings were held to review our service and the conclusions and recommendations are outlined under the following headings:

Training and Competence

All staff in GAS currently met the suggested competencies, but new physicians and ward nurses needed more training. Lunchtime tutorials for new physicians and in house study days on a quarterly basis for all staff were organised.

Procedures and Protocols

Our GAS policy manual covers met all the requirements and we have a standardized referral form and procedure.

Induction – The slow start induction protocol is used.

Dental Guidelines – The suggested one will be modified for use in Scotland – main changes will be to check INR 48 hours before extraction rather than 72 hours

Target Ranges -  high range to be 3-4 rather than 3-4.5.

Audit of Safety Indicators

DAWN AC should be able to provide most of these, although some will have to be completed manually. More work is required to improve annual patient reviewing.

Patient Education

All patients attending GAS clinics are referred using standardised form and have yellow books on first attendance.

Communication

Good communication exists between all healthcare professionals

Pharmacy & GP Communication – Some patients (particularly Domicilary patients) use dosette boxes.  Any changes in dose is phoned directly to pharmacy and sometimes to GP (if required).  This is done when nurse is with the patient.  Nursing home patients have the same service.

In conclusion, we have found that on the whole, our existing organisation and procedures are very well placed when measured against the NPSA Safety recommendations.