0.5 overcoming communication - 4s dawn · • all district nurse teams and pharmacies are now added...

0.5

3 5

1Overcoming Communication

Problems in the Anticoagulation

Service at CHFT

By Harry Crank

Administrator

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

• 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

0.5 3 51

Where are we?

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

Area of where we cover…

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

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

0.5 3 51

What Next? Future Plans…

• Email account

• Stop the use of internal faxing

• Redesign of patient request forms

• Telemedicine ?

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

Any questions?

Chairman: Andrew HaighChief Executive: Owen Wilson

0.5 3 51

Harry Crank

(01484) 355014

harry.crank@cht.nhs.uk

Contact Details: