PrescQIPP

Smarter DOAC Management - Optimising Safe Prescribing and Clinician Time through Technology

Nottingham West Primary Care Network

Project summary

This simple replicable project with a significant return on investment saves lives and major bleeds, NHS time and resource, with the use of the GP clinical system.

The BJGP1 and the NHS National Patient Safety Improvement Programme highlighted "one life saved or major bleed prevented for every 25 patients on a Direct Oral Anticoagulant (DOAC) whose dose is corrected, according to indication and renal function”

This project allows

  • Auto-calculation of Creatinine Clearance (CrCl) for patients on a DOAC on filing of U&Es,

  • Use of a dashboard to identify patients due and overdue for bloods, in need of an up-to-date weight, or potentially a dose change, simplifying the ever increasingly complex DOAC recall regime.

  • An individual level patient visualisation pulling all relevant information to aid clinical decision making around appropriate DOAC dosing.

Development of this tool saw:

  • 22% increase in number of patients on a DOAC with a CrCl.

  • 18% increase in test monitoring and recall adherence

  • 15% increase in patients with CrCl calculated and dose checked in comparison to previous year, now achieving in 94% of patients.

  • 1% increase in rate of dose changes for DOACS per month. Number of DOACS with dose changed: 11 April-November (1.4 per month), 15 Jan- march (5 per month).

  • One life saved or major bleed prevented for every 25 DOAC dose changes, therefore one life/ major bleed would be saved every 5 months with the new way of working, vs every 18 months.

  • Estimated saving to the NHS £27,480 in a year in one practice.

  • Reduction in time spent for pharmacy team – estimated 4-5 hours per week (saving £8271 per annum)

  • At initial roll out, one practice estimated a reduction of 10 hours of admin time per month.

This project has a return on investment of £290,953.

Local clinicians support the project: Dr James Read: “This is an excellent example of something that both improves safety and improves productivity- a rare thing.”

Professor Tony Avery stated: "Many patients are at risk of harm because they are not on the right dose of DOAC. The very impressive dashboard developed by the team at Nottingham West PCN goes a long way to addressing this problem. It improves test monitoring and recall adherence with associated improvements in recording of weight, and automatic accurate recording of creatinine clearance. Consequently, it also improves dosing of DOACs with likely benefits from reducing major bleeds and preventing deaths."