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Improving anti-coagulant prescribing in Warrington

Our review of anti-coagulant prescribing improved patient safety and reduced costs.

Direct oral anti-coagulants (DOAC) have now increased greatly as one treatment choice over the alternative warfarin. This is because they do not require the intense monitoring needed for warfarin. Patients on a DOAC will only require more routine monitoring once a year or every three months, depending on their renal function. Risks that need to be considered with taking a DOAC include under or over coagulation and continuing treatment for longer than necessary. It is important to check that those prescribed for atrial fibrillation (AF) are correctly read-coded to be on the AF register for their practice in order to ensure correct follow up.

In each Warrington practice, our MMO team conducted a review of all patients taking any of the four DOAC medicines currently prescribed across the CCG. They looked specifically at the risk factors with DOACs. These included indication, dose and duration of therapy, as patients may remain on the incorrect dose for the indication or a longer treatment length than necessary. Duration of treatment, and stop dates for courses, were documented in patient notes. Patients’ renal function and weight was reviewed for dose prescribed and amended as appropriate.

The team checked any drug interactions and also for appropriateness of medication for indication/risk factors ensuring the clinical indication was clearly documented by read code in the GP system.

For this project, the team created bespoke searches and numerical filters to show all existing values relating to DOAC monitoring.

The DOAC review was started in March 2018 across 27 GP practices in Warrington. The table below shows the interventions that were made by the MMO team:

Number of Patients in total from Searches on DOAC Number of patients currently on appropriate dose (at time of audit) Average % patients on appropriate dose Number of patients that require missing or appropriate Read code Number of patients that require treatment stopping or a dose reduction Number of patients that require dose increase
2426 2059 85% 116 (4.8%) 114 (4.7%) 21 (0.9%)

In addition to the safety aspect of this work there were £9,000 cost savings made in total.

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