The Anticoagulation Service at
Salisbury District Hospital
Nic McQuaid
And
Rachel Woodford
Anticoagulation Nurse Practitioners
Areas of Service
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Outpatient anticoagulation dosing
Inpatient anticoagulation dosing
New patient clinics
Outpatient DVT service
Nurse led thrombophilia service
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
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
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)
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
Outpatient DVT service
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AMU contact us for appointment
We aim to see patients same day or following
Patient given
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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.
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.
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.