1. The Anticoagulation Service at Salisbury District Hospital Nic McQuaid And Rachel Woodford Anticoagulation Nurse Practitioners

2. Areas of Service Outpatient anticoagulation dosing Inpatient anticoagulation dosing New patient clinics Outpatient DVT service Nurse led thrombophilia service

3. Outpatient dosing 2419 active patients Currently using DAWN (decision supporting software) Postal dosing service Near patient testing Telephone consultations Close contact with local GP surgeries

4. Inpatient dosing Dosing and monitoring as per patient need Average 15-20 inpatients in hospital at one time Available for general advice for nursing and medical staff. Discharge counselling service Plans for further education in this area

5. New patient clinics GP and outpatient referrals Patients seen usually within one week 30 minute slot with nurse to discuss and initiate treatment Patient provided with standard NPSA documentation (the yellow pack)

6. Outpatient DVT service Referrals originate from GPs, outpatient clinics, AMU and ED Seen in vascular department for scanning If necessary patient referred to pathology for routine blood samples Patient assessed on AMU and decision for anticoagulation made

7. Outpatient DVT service AMU contact us for appointment We aim to see patients same day or following Patient given –Advice on and initiation of warfarin –Education on Dalteparin administration –Organise community/practice nurses if necessary –Advice on leg care and compression hosiery –Ongoing support throughout length of treatment Letter sent to GP All patient data entered into VTE database, which allows prospective data capture. Referrals made into thrombophilia clinic if necessary.

8. Nurse led thrombophilia clinic Developed in demand to waiting list breaches and to decrease consultant workload Extension made to current in house VTE database Patient seen by nurse, full personal and family thrombosis history taken and entered onto database Thrombophilia screen performed if necessary and within recent guidelines Patient given personal, standardised advice on positive interventions to reduce risk of further VTE.

9. Nurse led thrombophilia clinic Electronic summary printed from database Majority of referrals closed by the nurse If patient needs medical advice referred into the monthly consultant clinic. Letter generated from database sent to patient, GP and copy into patients notes Decreased waiting times from average 10 weeks to 5, decreased consultant workload around 3 hours a month.