Aim To ensure that patients were safely

discharged on a Direct Oral Anti Coagulant (DOAC) through a quality

improvement initiative

Context The National Patient Survey stated that 54% of the 13,706 of respondents were dissatisfied with information given about side-effects of prescribed medication on discharge.

The prescribing of DOACs for the p r e v e n t i o n a n d t r e a t m e n t o f thromboembolism has been increasing exponentially: from 2013-2017 over an 800% increase.1 We chose to research this patient population due to the potential high-risk adverse side-effects of DOACs. Essential DOAC information needed simplification for ongoing patient safety and understanding.

What are we trying to accomplish?

Provide evidence through the research, design and implementation of a process for safely discharging patients on DOACs.

S.M.A.R.T. objectives:

N o v e m b e r 2 0 1 7 e n g a g e k e y stakeholders internally and in the community, produce a poster, patient leaflet and anti-coagulant sticker.

February 2018 retrospective research was undertaken in Cavan General Hospital of DOAC patients Fig. 1

April 2018 conduct pilot including education of staff by end April and create patient DOAC database as a KPI.

Team Yvonne Reilly, Olive Grall, Grace Crehan and Lorna Doran

What We Did

PLAN, DO, ACT :

CHECK: Telephone Survey in May 2018 to check for feedback from new DOAC patients.

Feedback from the 10 patient’s admitted in April/May 2018 to Med 3, CGH and prescribed DOAC indicates that the information was delivered correctly by hospital staff as 80% of patients understood their new medication.

Challenges encountered:

1. To reduce the scope of the project, to meet an achievable result in a specific timeframe

2. Stakeholder engagement – dealing with opposition to our project

3. The balance of work commitments alongside project development

1.  Thromb Haemost. 2012 Aug; 108(2):291-302.

2.  WWW.HSE.ie medicines mgt prog 2017 3.  WWW.Nala.ie

What We Achieved We achieved our S.M.A.R.T objectives by designing a quality improvement process to ensure the safe discharge of patients on a DOAC by engaging with key stakeholders, designing a poster, patient leaflet, cardex sticker, Fig. 2 and completing a post pilot patient survey for feedback.

Our process has been piloted in CGH and is being incorporated in CGH policy. Staff confidence in discharging patients safely on a DOAC has increased along with confirmed patient understanding.

Key Learning

Acknowledgements Mr Ray Bonar Mr. David Lynch Dr. B. Ni Bhuachalla Ms. Ciara Kirk Ms. Susan Moloney Ms. Rosaleen Cafferty Nursing Staff on Med 3 CGH Ms. Roisin Daly Mr. James Barrett

Ms. Lynda McGrory Ms. Sinead Nic Suíbhne Ms. Elaine Conyard Ms. Sarah Fagan Ms. Margaret Boland Ms. Judy McEntee Ms Fiona Connaughton

Discharge on Anti-Coagulant Therapy Safely (DOACs)

Yvonne Reilly, Grace Crehan, Olive Grall, Lorna Doran

•  Identify what you want to achieve or your end goal very early in the project.

•  Key stakeholder buy-in is essential

•  Get to know your team strengths and weaknesses

•  Set clear goals and deadlines

•  Limit your scope to ensure an attainable end goal.

References

Fig. 2 Poster, leaflet and sticker, staff and patient education and feedback.