0.5 overcoming communication - 4s dawn · • all district nurse teams and pharmacies are now added...
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1Overcoming Communication
Problems in the Anticoagulation
Service at CHFT
By Harry Crank
Administrator
Chairman: Andrew HaighChief Executive: Owen Wilson
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• 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
Brief overview of our Service
Chairman: Andrew HaighChief Executive: Owen Wilson
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Where are we?
Chairman: Andrew HaighChief Executive: Owen Wilson
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Area of where we cover…
Chairman: Andrew HaighChief Executive: Owen Wilson
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History of our Service1995 – 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
Chairman: Andrew HaighChief Executive: Owen Williams
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What have we improved?
�Patient dosage letters
�GP dosage letters
�Telephones
�District Nurses / Pharmacies letters
�Yellow Record Book Stickers
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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, theDescriptionTemplate was changed to include the LetterName (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.
Chairman: Andrew HaighChief Executive: Owen Wilson
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GP Dosage Letters
Letters sent electronically
�GP Dosage
�NPSA annual review
�Non-Attendance
�Discharge for Non-Attendance
�Non-Compliance
�End of Treatment Stop
�Referral Confirmation
�Transfer to Primary Care POCT
October 4234
November 4192
December 3482
January 4524
February 4212
March 4345
April 4670
May 4858
June 4542
July 4794
August 4436
TOTAL 48289
Chairman: Andrew HaighChief Executive: Owen Wilson
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GP Dosage Letters
Old Process
Printing, folding and sorting
of 200+ GP letters ~ 2
hours/day
Changed printer cartridges
every 1 – 2 months
Used lots of paper &
envelopes
GP received letters 3-4 days
later
New Process
All GP surgeries on ‘portal’ are
sent everyday
The out of area GP’s still print
but only about 10 letters / day
Printer cartridges last 4-5
months now
75% of GP surgeries receive
their letters the following day
More time to do other tasks
A saving of ~ £800 / year
Chairman: Andrew HaighChief Executive: Owen Wilson
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Telephones
1 x Fax
1 x Telephone
1 x Fax
3 x Telephones (same number and 2
headsets)
1 x Scanner (to attach letters,
referrals on to patient notes in Dawn)
Past Present
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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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
Chairman: Andrew HaighChief Executive: Owen Wilson
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What Next? Future Plans…
• Email account
• Stop the use of internal faxing
• Redesign of patient request forms
• Telemedicine ?
Chairman: Andrew HaighChief Executive: Owen Wilson
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Any questions?
Chairman: Andrew HaighChief Executive: Owen Wilson
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Harry Crank
(01484) 355014
Contact Details: