Implementing the change from DAWN v6 to v7 in a Regional General Hospital s Anticoagulation Clinic

1. Implementing the change from DAWN v6 to v7 in a Regional General Hospital�s Anticoagulation Clinic Rhys Daltrey BMS2 Southend University Hospital NHS Foundation Trust

2. Anticoagulation service at Southend Centralised monitoring service paid for by PCT Approx 3800 patients are members of the clinic Tested at EITHER Anticoagulation Clinic via capillary blood test OR Remotely at local clinic by venepuncture

3. Anticoagulation Clinic Run 3 times a week (Mon, Thurs and Fri) Approximately 20% of patients use this service (approx 600 patients) Capillary blood test performed on Thrombotrack INR used to dose patient using by Biomedical Scientist using Dawn or manually by pharmacist Limited in terms of number of patients on site. Therefore we developed Postal Dosing approx 10 years ago.

4. Postal Dosing Used by approx 80% of patients (3200 patients) Venepuncture at local clinic sent to lab by courier INR tested on IL ACL-Top analysers INRs imported onto Dawn electronically INRs reviewed by BMS staff and dosed using Dawn or by pharmacist Patients phoned with dose changes and letters sent in post

5. Breakdown of Clinic numbers Most patients tested at local clinic Minority of patients tested at home by District Nurses, Domiciliary Phlebotomist or self testing patient using Coagucheck XS

6. How we used Dawn v6 in the Anticoagulation Clinic Patients arrive at Hospital, take a ticket and wait to be seen in turn Tested via capillary blood test by MLA staff Result entered on Dawn v6 by BMS staff, dose label printed off and entered into yellow book Patient either sent home or to pharmacist for dose review according to pre-defined rules Ancillary tasks involve booking transport for patients

7. How we used Dawn v6 in the Postal Dosing Clinic Patient samples arrive in lab Generate requests on Lab system Samples centrifuged and then run on analyser INR results imported to Dawn v6 by batch import function Dosing work lists generated and assessed by BMS staff, handed to Pharmacy staff for authorisation Authorised doses then processed and phoning work lists produced Phoning work lists processed by MLA staff Ancillary tasks included booking domiciliary visits by phlebotomy staff and District Nurses

8. Why we wanted to change from Dawn v6 to Dawn v7 Biggest impact to be in our Postal Dosing Clinic Reduce paperwork (approx 200 sheets A4 a day!). All of which needed permanent or semi-permanent storage Remote dosing, important with our tiny lab Security and audit issues (NICE and CPA guidelines)

9. Dawn v6 Paperwork

10. Remote Dosing We have a small lab, not much room for 9 people in the afternoons Increasing workload meant even more staff required Needed more space, either move people out or move to a bigger lab

11. Security and Audit Issues NPSA and CPA guidelines indicate that full audit of all data entry was required This ties in with permanent storage of all of our paperwork Dawn v6 could not achieve this electronically and so v7 was a necessity

12. Preparing for Dawn v7 Transfer v6 functionality to v7, getting round our old cheats! GP data clean up Clean up of patient data Set up print station PC Change letter formats to HTML Set up list views

13. Additional benefits from Dawn v7 Dawn v7 has made it easier to implement appointment times in our clinic Use Dawn Mailer to streamline and improve our printing E-mail doses to patients Stat doses appear on dose, not in comments, better for patients

14. Where we are now Nearly paperless system, down from 200 to approx 35 sheets a day Full audit possible (CPA requirement) Appointment time system in place, was possible with v6 but v7 makes it really easy

15. What we would like in an ideal world Networked label printers to automatically print dose labels in clinic Proper storage of documents on Dawn, not just barcodes Auto e-mail transport bookings Auto telephony

16. Our list of suggested �improvements� for Dawn v8! Better message centre Easier to use contact methods Automatically deactivate patient record when treatment plan stopped More logical ordering on list views Preferred appt days as well as appt times

17. What else do you need to convert to Dawn v7?