Oral Anticoagulation Operational Guidance for …

1 Approved by: On: Review Date: Directorate responsible for Review: Policy Number: Signature: NHS LCR CHS Clinical Quality and Governance Committee 14th June 2010 23 August 2010 Quality 14th June 2011 NP109 ..Liz Rowbotham Director of Quality Oral Anticoagulation Operational Guidance for General Practice in Leicestershire County & Rutland Equality Impact Assessment Policy/ Service Screening Checklist Policy Title: Oral Operational Guidance for General Practice in Leicestershire County & Rutland Directorate: Quality Name of person/s auditing / authoring policy: Mike Passfield Policy/ Service Content.

2 For each of the following checks is this policy sensitive to people of different age, ethnicity, gender, disability, religion or belief, sexual orientation & transgender? The checklists below will help you to see any strength and / or highlight improvements required to ensure that the policy / procedure is compliant with equality legislation. 1. Check for DIRECT or INDIRECT discrimination against any minority group of SERVICE USERS: Response Action required Resource implication Question: Does your policy/service contain any issues which may adversely impact people from using the services who otherwise meet the criteria under the grounds of.

3 Yes No Yes No Yes No Age X Gender (Male, Female and Transsexual) X Learning Difficulties / Disability or Cognitive Impairment X Mental Health Need X Sensory Impairment X Physical Disability X Race or Ethnicity X Religion or Belief (including other belief) X Sexual Orientation X If yes is answered to any of the above items the policy may be considered discriminatory and requires review and further work to ensure compliance with legislation. 2. Check for DIRECT or INDIRECT discrimination against any minority group relating to EMPLOYEES: Response Action required Resource implication Question: Does your policy/ service contain any issues which may adversely impact employees from operating the under the grounds of.

4 Yes No Yes No Yes No Age X Gender (Male, Female and Transsexual) X Learning Difficulties / Disability or Cognitive Impairment X Mental Health Need X Sensory Impairment X Physical Disability X Race or Ethnicity X Religion or Belief (including other belief) X Sexual Orientation X If yes is answered to any of the above items the policy may be considered discriminatory and requires review and further work to ensure compliance with legislation. TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING DIRECT or INDIRECT DISCRIMINATION = Number of Yes answers for Service users (A) 0 Number of Yes answers for Employees.

5 (B) 0 Yes/ No Comments / Is there any evidence that some groups are affected differently? No Is there a need for external or user consultation? No If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? No Is the impact of the policy/ Guidance likely to be negative? No If so can the impact be avoided? N/A What alternatives are there to achieving the policy/ Guidance without the impact? N/A Can we reduce the impact by taking different action? N/A IMPACT (Please Tick) High Medium Low x To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.

6 If you have answered Yes to any of the above questions, it is likely the policy/ service will need a full assessment. Please complete the full EIA template. If you have identified a potential discriminatory impact of this procedural document, please refer it to policy/service administrator; together with any suggestions as to the action required to avoid/reduce adverse impact. CONTENTS SECTION NUMBER SECTION DESCRIPTION PAGE NUMBER Introduction Aim, Objectives, Exceptions 1 1. Setting up in the Practice Set up register of patients on Warfarin Using a Patient Specific Direction (PSD) Establishing a Standard Operating Procedure (SOP) for INR 2 2 4 2.

7 GP Accepting Stable INR Warfarin Patients from UHL and Community Hospitals Process Flowcharts 5 12 3 Housebound Patients Pathway for monitoring stable patients Unstable patients 16 16 4. GP Concern Regarding Patient Stability 3 step process to access nurse led clinic for advice 19 5. Adjusting Warfarin Dose in General Practice Dosing Advice to Patients having Dental Treatment Pre-Operative Management of Warfarin Discontinuing Warfarin 19 21 21 21 6. New Patient in General Practice Requiring Warfarin Warfarin Initiation schedule & prescription chart for slow initiation treatment 21 7.

8 Practice Clinic Processes Patient 1st Appointment Patient follow up 26 27 APPENDICES 1 Staff Competency. Assessment Criteria 28 2 Near Patient Testing and Maintenance of Oral Anti-coagulation Therapy in Primary Care Standards and Criteria (NPSA Standards) 37 3 Quality Control and Assurance 39 4 Outline of areas to be covered by the SOP 42 5 Side Effects of Warfarin 46 6 Factors That Affect Anti-coagulation Control 48 7 Audit. Minimum Standards NPSA 53 8 Critical Incident / Significant Event Analysis 54 9 Procedure for Obtaining Supplies of Testing Strips and Control Solution 56 10 CoaguCheck Machine Internal Quality Control Log Sheet 57 11 External Quality Control Check 58 12 External Check: NEQAS.

9 General Information NEQAS Registration Form 61 13 UHL Patient Induction Pack 62 NP109 Anticoagulation Operation Policy Page 1 of 70 Status final, version 1 Approval date; June 2010 Review date; June 2011 Anticoagulation MONITORING Operational Guidance FOR GENERAL PRACTICES AIM To offer therapeutic Anticoagulation management to practice patients receiving Anticoagulation therapy by means of Near Patient Testing (NPT) and Computer Decision Support.

10 To provide best practice Improved patient safety Optimise anticoagulant control Reduce number of INR tests required to maintain good control Reduce potential for errors in dosing Improve patient convenience Improve efficiency in the use of medical time and resources OBJECTIVES Decrease the risk of thromboembolic events or extension of an existing event by monitoring patients at the optimal level of Anticoagulation therapy without producing an unacceptable risk of haemorrhage. Enable optimum care to the patient in terms of accessibility, number of blood tests, waiting times for results, appropriate dosage advice, clear written information and continuity of care.