1. ADAS Anticoagulant Dosing and Advisory Service
Bev Straker-Bennett / Sean O’Brien
Senior Specialist Anticoagulation BMS’s
Jan 2018

2. Service Provision
ADAS is a Consultant led service managed by the Pathology Directorate.
Provides POCT and computer assisted dosing advice to registered patients on oral anticoagulant therapy.
The service is delivered by Biomedical Scientists, Nurses and Medical Laboratory Assistants.
All clinics are community based.
Daily housebound patient service.

3. Community Clinic sites

4. Additional provision Direct link to outpatient DVT service.
Pre op management of patients awaiting Cardioversion or Ablation.
Pre and Post op management of Colonoscopy patients.
Pre op management of Cataract patients.
Reversal of over Anticoagulated patients with Oral Vitamin K, including 24 hour follow up, within community clinics.
DOAC’s Initiation / safety checks / drug switches, 3 week follow up

5. Cardioversion management
Comprehensive Initiation / Education for all new starters. Warfarin and DOAC’s
DOAC safety checks / 3 week follow up
Fully compliant with NPSA recommendations
ADAS Blackpool
Fylde
Wyre
BVH
Wards
Point of care
Team
Gastro- Enterology
Colonoscopy
Opthalmology
Cataract patients
Ambulatory
DVT services. GP Led
Cardiology
Ablation
Cardioversion management
Comprehensive management of patients awaiting cardiovascular procedures
Warfarin dosing for intermediate care units.
Management of pre procedure INR levels.
Direct links with DVT service.
Pathway for LMWH developed by ADAS.
Management of pre procedure INR levels.

6. Current DOAC concerns
Variation in initiation between medics both primary and secondary care.
Inconsistent education for patients
Patients presenting to ADAS clinics for advice.
Patients prescribed a DOAC with contraindications.
Patients on both warfarin and a DOAC.
Switches done without renal bloods or INR checks. NICE guidance not followed.
Switches done when INR is above recommended level (bleeding risks).
Patients on the wrong doses of DOACs / no follow up checks.
GP’s / nurses phoning ADAS for DOAC advice and switch assistance.

7. Proposed Simple Safe Pathway for all Anticoagulants
Patient requires Anticoagulation
Proposed Simple Safe Pathway for all Anticoagulants
Medics to discuss options with patient following trust guidelines and prescribe appropriate Anticoagulant.
NEXUS referral made to Adas. DOAC or Warfarin
Anticoagulation Initiated by Medic
Anticoagulation Initiated / switched by Adas
Education on chosen Anticoagulant. Safety Checks performed. Patient registered on centralised database
Warfarin
INR checked. Dosed amended/initiated. Follow up appointments in clinics arranged.
DOAC
Patient seen for three week follow up appointment to discuss issues/side effects
Regular monitoring TTR/VGR review. Reports sent to GP
Discharged to GP care.
All carers informed of medication changes if a switch of Anticoagulant has occurred

8. Benefits of the pathway
Centralisation of all anticoagulant patients (universal anticoagulant database).
Auditable, consistent, comprehensive education for all patients/carers.
Less Medic time/confusion on who is educating patients.
Safe medication switches.
Secondary safety check to ensure:
no contraindications (drugs or conditions)
bloodwork is done and results appropriate
correct dosage
appropriate treatment duration
3 week DOAC review
Compliance for NRLS (NPSA) / NICE recommendations.