INRstar provides location-specific webinars to help users make the most of their anticoagulation solutions. The webinars and training are designed around the needs of the organisation and INRstar can provide bespoke training to new INRstar users or refresher sessions for existing users.
The Federation currently oversees the Out of Hospital anticoagulation service provision for around 2,225 patients. As Lead Nurse at the Hammersmith and Fulham GP Federation, and the Community Education Provider Network (CEPN), Vicki Newport’s main role is around Quality and Clinical Assurance of services and training provided for the clinical and non-clinical staff in Hammersmith and Fulham.
Vicki explains: “At the beginning of this year, I took up a Quality Improvement project as part of a Fellowship. As part of the project, we carried out an audit in all practices providing the service; the audit identified gaps in knowledge in the way the service was delivered, below national average TTR’s (Time in Therapeutic Range) and clinicians not using the INRstar software to its full potential. They knew how to enter the data, but were not routinely using it to run reports or to carry out internal or external quality control. Some practices were not aware that patients on direct oral anticoagulants (DOACs) should be monitored on INRstar. We spoke to the team at INRstar to discuss the different options for training. We thought it would be a good approach to provide some mandatory training sessions across the practices within the Federation. We requested a 2.5 hour webinar, which would be bespoke to each practice providing the anticoagulation service.
“INRstar’s Clinical Services Advocate was excellent at looking at surgery-specific issues and linking these to the training.” Vicki Newport, Lead Nurse, Hammersmith and Fulham GP Federation.
“The team carried out the process in stages and identified the high need practices and targeted those first. Vicki explains: “The entire process worked really well and feedback was excellent. We tried to ensure that at least one clinician, one practice nurse and a Health Care Support Worker / HCA were present at the seminar; practice managers were also invited to attend. In most cases, it was the GPs who didn’t know how to use INRstar to its maximum potential. The great news is that since the seminars, the practices have all upped their game – it’s all been really useful.”
Vicki explains that there had been difficulties getting GPs to register online before the seminars, this would give the practice and trainer an opportunity to discuss specific training issues relevant to that practice. Vicki says: “As a result of the audit and my practice visits, I was able to convey these concerns to the INRstar team, i.e. TTR well below national average, and make sure that this was put into the training. Some practices were not always monitoring their patients who were on direct oral anticoagulants (DOACs) and didn’t realise they could do this in INRstar – so this has been really useful to spread the word.” Vicki has found that the practices who are well established on INRstar with good results, were then able to spend time focusing on calibrating their own internal quality, protocol and policy. Vicki also had the opportunity to reiterate the HCAs and practice nurses’ Scope of Practice and accountability to ensure the level of responsibility was set on the system.
Vicki says: “They have been learning from each other and from other webinar sessions. INRstar have been very accommodating in meeting the needs of the practices. Working with Julie has worked really well, with absolutely no problems with the service or training – it’s all gone really smoothly.”
The Federation has also purchased INRstar analytics to determine the baseline. Vicki explains: “This is great and really helps us to get an overview of where the practices are in their TTR and monitoring and this will help us assess the training impact. We expect to see an improvement in TTR.
“In the near future, the community anticoagulation service will be decommissioned and the practices will take over the monitoring. Several hundred patients who have unstable and complex conditions will be discharged into general practice. Vicki says: “We feel the practices are more confident in providing the service, and we know now that they will be going to a practice that is providing high quality and safe care. This was part of the rationale for purchasing INRstar analytics as we knew it would be up to standard for the CCG handing over the patients.”
Vicki and the team have also been promoting the use of INRstar’s functionality External Patient Lookup.
Vicki says: “External Patient Lookup will be really useful. With more practices doing Out of Hours and extended hours, having this option will be really useful for the patients and practices.”
Vicki concludes: “INRstar’s Clinical Service Advocate Julie Varley, was excellent at looking at surgery-specific issues and linking them to the training. If there were any comments, she would refer back to the Commissioning specification and offer further advice and guidance. Good communication and regular feedback has been essential in leading to the success of this project.”
There are plans to maintain contact with INRstar, review the benchmarking and refocus on the service to determine if the training has made a difference.
Tags: anticoagulation, Direct Oral Anticoagulant, DOAC, External Patient Lookup, INRstar, INRstar analytics, INRstar training, Newer/ Novel Oral Anticoagulant, NHS Hammersmith and Fulham GP Federation, NOAC