The Eston Surgery
Dedicated to family care
Anti-coagulation service
Patient experience survey
20/06/2014
Produced by Claire Hutchinson
Practice Manager
Methodology
Fifty one patient experience questionnaires were posted out with a cover letter
on 8th April 2014 with a stamped addressed envelope enclosed.
The patients chosen for the survey are on our Warfarin register and had all utilised the anticoagulation service in the preceding 3 months.
Twenty-nine questionnaires were received back
The information collated from the survey is used to improve the service we provide.
Questions asked
1. Did you feel involved and able to influence the treatment and information /education you
received as part of the anticoagulation service?
Options - Yes / No / Not applicable
2. Do you feel that the treatment, information and education you received was right for your
needs?
Options - Yes / No / Not applicable
3. Were you given written information about your treatment programme and information to help
you better manage self-manage your condition?
Options - Yes / No/ Not applicable
4. Was the written information made available in a format that was easy for you to understand?
Options - Yes / No / Not applicable
5. Were you given a copy of the NPSA oral anticoagulation therapy pack (Yellow pack & book)
Options - Yes / No / Not applicable
6. Do you feel you were treated with dignity and respect during your appointments at the
anticoagulation service (e.g. appointments for INRs and receiving the results and doses etc.)
Options - Yes, all of the time / some of the time / No / Not applicable
7. Do you feel that the anticoagulation service enabled you to better manage your condition on
you own?
Options - Yes / No / don’t know
If yes, can you tell us how?
If no, can you tell us why?
8. Overall how would you rate the anticoagulation service provided by your GP practice?
Options – Excellent /Very good / Good /Fair / Poor
Results
1. Did you feel involved and able to influence the treatment and information /education
you received as part of the anticoagulation service?
Question 1
yes
no
7%
not applic/not answered
10%
83%
2. Do you feel that the treatment, information and education you received was right
for your needs?
Question 2
yes
no
not applic/not answered
4% 3%
93%
3. Were you given written information about your treatment programme and information to
help you better manage self-manage your condition?
Question 3
yes
no
not applic/not answered
7%
17%
76%
4. Was the written information made available in a format that was easy for you to understand?
Question 4
yes
no
not applic/not answered
17%
7%
76%
5. Were you given a copy of the NPSA oral anticoagulation therapy pack (Yellow pack &
book)
Question 5
yes
no
not applic
0%
7%
93%
6. Do you feel you were treated with dignity and respect during your appointments at the
anticoagulation service (e.g. appointments for INRs and receiving the results and doses
etc.)
Question 6
all of the time
some of the time
0%0%
7%
93%
no
not answered
7. Do you feel that the anticoagulation service enabled you to better manage your condition
on you own?
Question 7
yes
no
don’t know
not answered
3%
41%
52%
4%
When we asked you - Did you feel the service enabled you to better manage your
condition on your own?
Your comments were:-
“Yes - getting the correct dosage right after regular checks enables me
to take the right dose”
“Yes - everything was explained in plain English”
“Yes - the INR results are always ready on time and the dosage is
altered accordingly”
“Yes - food and stuff that l keep away from”
“Yes - it made it easier to understand what I need to do”
“Yes - just being able to talk about things concerning my treatment”
“No - no basic information”
“Yes - I feel more in control of my condition”
8. Overall how would you rate the anticoagulation service provided by your GP practice?
Question 8
excellent
very good
4%
good
fair
poor
not answered
3%
0% 0%
38%
55%
“I am very satisfied with the help and advice of the medical team and all the
staff for my regular tests which keeps on top of my medical conditions”
“No overall information or backup support or contact”
“Not really happy about dosages of Warfarin. E.g. on 8mg so have to take 2 x
3mg and 2 x 1mg, 4 tablets in all, when I’ve heard that there are 5mg tablets,
then I could take 1 x 5mg and 1 x 3mg, two tablets in total
“
“I think you could improve the service if it could be put on to the internet in the
same place where you can book your own appointments. It is covered by a
password so it can be kept private. It will eliminate the need to phone up taking
up receptionist’s valuable time. Making sure that it is delivered accurately and
can be re-checked if need be”
“Out of the district Nurses who have visited me, only two of them have
disinfected their hands before taking my blood. I think this should be every
time”
“nice staff - they always phone me if I forget to ring for my results”
“the service is good at the surgery, I did not get any information from the
hospital and there were problems when the hospital were working out my tablets
and I had to phone them
“
“In answer to questions 1 & 2. I put my trust in the doctor and nurse about my
treatment and medication - thank you”
“regards to the yellow book, I was not given one at my last surgery,
only when I came to your surgery”
“Have been treated by the Eston Surgery for 31 years - not one complaint”
Conclusions
 83% of patients felt involved in their treatment and felt they had an influence in the
information and education provided, 10% didn’t know or answer, 7% of patients felt they
were not involved.
 93% of patients felt that the treatment, and information and education were right for their
needs. 3% didn’t know or answer, 4% of patients felt it wasn’t.
 76% of patients were given written information to help better manage their own condition,
7% didn’t answer or didn’t know. 17% were not given information
 76% of patients felt that the information was easy to understand, 17% didn’t answer or
didn’t know and 7% felt it wasn’t.
 93% of patients were given a NPSA oral anticoagulation therapy pack (yellow pack and
book) and 7% didn’t receive one
 93% of patients felt they were treated with dignity all the time, 7% some of the time, no
patient felt they weren’t treated with dignity
 52% of patients felt that the service enabled them to better manage their condition, 4% felt
it didn’t, 41% didn’t know and 3% didn’t answer.
 Overall, 55% rated the surgery’s service excellent, 38% rated it very good and 4% rated it
good. 3% didn’t answer, and 0% rated it fair or poor.
 The majority of affirmative answers scored highly, which is great news, Most of the
comments were positive; again, this is great news. The ideas were constructive and
helpful, there are a couple of areas that we will improve on to make the service
better for you.
Action plan for the surgery
 Although the survey was anonymous, some patients did put their names on them, this
aided the assessment opportunistically by providing an informal breakdown of home and
surgery users. There does seem anecdotally to have been less information offered to our
long term housebound users in the past. We will ensure this does not happen in the future.
We will telephone our current users, checking if they need some advice/information post
out information in a format suitable for their needs and post out a full starter pack for the
new users.
 We will ensure that the patients who attend the surgery and those who have their INR
taken at home feel more involved in their treatment and the education / information they
receive is right for them, we will do this by making information and education easier to
access. Patient leaflets about lifestyle and diet, and education hand-outs will be offered to
patients attending for their INR blood tests, in addition to the verbal information given by
the health care professionals. We will endeavour to provide this information in a format
that is suitable for the needs of the individual patient.
 We will ensure that all patients have a copy of the yellow NPSA booklet, and the yellow
card needed for collecting your prescription at the chemist
 We will pass on the findings of this survey to our district nursing team who visit patients on
our behalf to take INRs
 We will continue to monitor this service by using the “friends and family” test
 We will share our survey results and action plan with the patients who use this service and
at www.estonsurgery.co.uk and also with NHS CCG (South of Tees Commissioning
Group) who commissions the surgery to undertake this service
In relation to some of the specific comments and suggestions:
 Thank you for your suggestion to have an on-line results service. To keep up with modern
technology, we will consider offering test results on line or by text in the future; however for
this service there are just too many safety concerns for this particular drug to even
consider it.
The reason for this is that the surgery has to keep a complete audit trail of when each
patient had their test, the result, the dose signed by the clinician, the date the patient was
informed of their results and given their dose and their next due date for their next INR
(and book the appointment / added to District Nurse diary)
In addition to this we also keep a record if the patient hasn’t rang for their results, and an
audit of each attempted call/failed encounter for safety reasons.
The surgery also submits annual data to the South Tees Commissioning Group (previously
known as our PCT) as part of quality assurance and safety. If a patient were given access
to this service on line, the GP would have no way of knowing if the patient had retrieved
their results, understood a change in dose and their booked their next appointment.
All our staff are aware of the safety concerns around this drug and are extremely vigilant.
For example, if a patient fails to attend an appointment or hasn’t rang for their results, our
team automatically phone to rebook/give results. Our receptionists are always happy to
speak to our “Warfarin” patients and ensure that the results and appointments are handed
over.
 Thanks for your suggestion about including 5mg tablets as part of your prescription. There
are indeed 5mg tablets available. Again for safety concerns, the practice agreed (in line
with national guidance) some years ago to discontinue prescribing them with 0.5mg tablets
due to the risk of 5mg being mistaken for 0.5mg. There were some patients were under
dosing and some were overdosing both with serious consequences
If you have never had 0.5mg on your prescription, you may wish to speak to the GP (by
telephone consultation) to discuss the risks and benefits of having 5mg prescribed
 Thank you for completing this survey, we appreciate your opinions, comments and
feedback as it helps us to improve the quality of the service we offer