1. Safety in Practice Learning Session 3 PHO and Facilitator: Procare Team members: Sandra Hewlett Audrey Cassidy and Dr Cliff AhKit Manukau City Accident and Medical Centre

2. Safety in Practice Name of Audit Tool Aim: Warfarin Bundle Briefly describe what you were trying to achieve in your practice Paperless system of INR Monitoring Greater Compliance/stability of INR patients Better Education re Warfarin to patients and staff.

3. Safety in Practice Change Ideas Driver Diagram Moving from a paper system to automated has improved compliance and reduced time of Doctors as Nurses are now managing the entire process. Increase education to the patients.

4. Safety in Practice Change Package Change TestedOutcome / Evidence of Improvement 1 Paperless systemMost Inr results are sent my email. Recall system used to identify patients due on a daily basis. Compliance spreadsheet updated and checked daily. 2 ComplianceUsing Spreadsheet data has been able to identify non compliant patients earlier and work with them. Extended times between tests for compliant, stable patients. 3 EducationThrough education – better compliance and stability have been achieved allowing more time to educated non compliant unstable patients.

5. Safety in Practice PDSA Cycles Which PDSA provided the most learning for your practice? Development of BEST PRACTICE Which PDSA was the most succssful? Development of Best Practice with the use of recall audit system and spreadsheets.

6. Safety in Practice Measures Summary Briefly describe what you are measuring and how and why? We are measuring how successful the educational data is for our patients. How often patients are being tested How compliant our patients are Have our patients become more stable. Have we been able to identify reasons for non compliance.

7. Safety in Practice Measures Summary

8. Safety in Practice Achievements to date Do you have an -agreed aim – Paperless system – greater compliance/stability -a change package – Best Practice -measurement plan – Using spreadsheet we can quickly identify patients missing tests. Do people on your team know what their responsibilities are and what is expected of them? YES What has changed and what difference have the changes made? Less time spent on INR Management Few Patients on Warfarin Better Educated patients Greater Compliance/stability Fewer INR test by stable patients.

9. Safety in Practice Trigger Tool / Climate Survey Please provide a summary of your experience of using either the trigger tool or the climate survey and subsequent actions taken following the use of either of these tools  We have noticed that patients who are beginning to deteriorate from other causes show INR instability earlier than some other systems.  When usually stable patients have an INR reading our of the ordinary we call them, discuss possible causes and seek assistance from their core team.

10. Safety in Practice Any other achievements? Add any thing else you’d like to share here: -How the work has impacted your team -Anything else you think might be useful to share 1.This has given the Nursing staff greater confidence to begin other Nurse lead projects in the practice. 2.Leads the practice to a paper free work environment 3.Nurses have taken on the task to relieve doctors for compliance due to time restraints.

11. Safety in Practice Highlights and Lowlights -What has been the experience of the team (General Practitioners, nursing and administrative staff and patients) in terms of their involvement in the improvements that have been made -Less time spent on INR management. -Better patient contact and understanding -More confidence in moving to paper free systems in the practice.