Royal Pharmaceutical Society

Anticoagulation service re-design due to COVID-19

by Ed Matthews, Lead Pharmacist of anticoagulation, Royal Glamorgan Hospital

The pandemic has had significant implications for anticoagulation management. Our pharmacist led anticoagulation service has traditionally focused on patients older than 70,have cardiac/respiratory conditions and the immunocompromised – patients who could be fatally affected by COVID-19.Our ability to adapt at pace to change the way services were run to protect vulnerable patients was there a key priority for us with the outbreak of COVID-19.

We took a number of important steps to achieve this. The initial step was to move as many of the vulnerable patients to remote dosing as soon as possible. We were are able to procure self-test machines so that patients could take a finger prick sample of blood and check their own INR and phone the result into the clinic. We identified patients that would benefit the most from self – testing their INR. The next challenge was to train them, so we decided to use a smaller non-acute hospital within the health board were there was no confirmed COVD-19 cases. The patients were all successfully trained within the space of 1 week and could then self-isolate successfully.

The next step was to identify patients that could be switched from warfarin to a drug that would not require regular blood tests such as a Direct Oral Anticoagulant (DOAC). After reviewing each patient and counselling them we were able to switch 11 patients from warfarin to a DOAC.

Our final resort if patients were unable to take their own INR or switch to a DOAC was to try and transfer to the GP for blood tests or ask a district nurse to go and take a blood result from the patient so our clinic can dose over the phone.

The remaining patients that had no option but to attend the hospital for their INR were able to visit a non-acute hospital where social-distancing measure could be maintained. Our pharmacist practitioners also wore suitable PPE in order to reduce the risk of virus transmission. This also provided reassurance for our patients that it was safe to come and have their INR measured.

Over a 2 months period we were able to avoid an estimated 211 appointments and managed to prevent 76 patients from needing to attend a hospital for a blood test. The changes to our service has meant that more practitioner work can be done remotely so this has allowed for staff members to work from home if they have been required to self-isolate.

The RPS Future of Pharmacy in a sustainable NHS highlights the need for pharmacy teams to support a seamless patient journey, to assurance the safety of pharmacy teams and maintain patient safety at every step. I believe that our service re-design has achieved this, and I am proud to be part of making these changes.

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