As a result of the COVID-19 pandemic, national guidance had been issued to keep patients prescribed anticoagulants as safe as possible. This identified risks to patients and staff from attending anticoagulant hubs for INR monitoring and the detrimental effect COVID-19 could have on warfarin control. Amongst the recommendations were to switch appropriate patients to a DOAC in a phased approach over the 12 week cycle of INR monitoring.
North Yorkshire CCG and the anticoagulant clinic at Harrogate District NHS Foundation Trust proposed a project to identify patients with poorly controlled INRs and patients at higher risk if exposed to COVID-19, e.g. shielded patients. A protocol was produced which was approved by the CCG and the consultant haematologists. A pharmacist was recruited to lead on the project to allow quick and efficent implementation of this project as at the time there were signifcant pressures on staff time within the hospital and in GP practices. The pharmacist coordinator was able to work across the sectors (general practice, anticoagulant clinic, haematology consultant) and access resources not easily available to one sector e.g. he could access INR and blood data from the anticoagulant clinic and have access to the GP record to check for contraindications; to prescribe and to make clinical records.
In total 100 patients were reviewed and of which 82% accepted a change to a DOAC. This protocol meant that patients were followed by the same pharmacist a week after the change to make sure to check they had received their medicine and had made the change; that they were taking the DOAC; were not accidently taking warfarin still; to see if they had any potential ADRs and to answer any questions and concerns they may have had. Overall this project was effective at providing a safe and efficient review of patients with a view to switching to a DOAC at the height of the COVID-19 pandemic.
