A collaborative project by Barts Health NHS Trust, CEG, UCLPartners and east London clinicians has been shortlisted for Best use of integrated care and partnership working in patient safety at the HSJ Patient Safety Awards 2022. The team worked to reduce strokes in people with the heart condition atrial fibrillation (AF) by increasing the use of life-saving anticoagulant medications. In the first 12 months, anticoagulant prescription rates in people with AF in the region reached 95% – well above the national target of 90%.
Atrial fibrillation (AF) is a heart condition that causes an irregular heartbeat, blood clots and stroke. Anticoagulant medications reduce the risk of stroke in people with AF by more than half, but many people are not prescribed them. Prior to the initiative, the percentage of AF patients prescribed anticoagulants in the London boroughs of Barking and Dagenham, Havering and Redbridge was 87%, 83% and 84% respectively1. This put Havering and Redbridge in the bottom 10% of Clinical Commissioning Groups in England.
Barts Health pharmacists led a campaign to tackle the issue, which is also a priority in the NHS Long Term Plan. They worked with hospital doctors, GP surgeries and community pharmacists from across the three boroughs. With the help of CEG and UCLPartners, they reviewed the treatment plans of around 10,000 patients diagnosed with AF.
CEG provided a software tool for clinicians to use: the ‘Active Patient Link tool for Atrial Fibrillation’ (or ‘APL-AF’). Using the tool, a GP or pharmacist can search their practice register in minutes to see a list of patients with AF and rapidly view whether they are taking an anticoagulant or not. In each patient, different factors influence the best treatment options. Without leaving the tool, the clinician can see relevant factors about an individual, including their blood pressure, other health conditions and other medications. This information is used to call patients for a face-to-face consultation to start anticoagulation.
An advice service was set up by specialist cardiac pharmacists from Barts Health NHS Trust to discuss the suitability of the medication in the most complex patients. And an educational programme was created to raise awareness of anticoagulants amongst pharmacy staff and health care assistants. CEG also built a dashboard to monitor the region’s performance in near-real time.
1 National Quality and Outcomes Framework (QoF) data, 2019/2020.