A new digital health screening
service introduced by County Durham & Darlington NHS Foundation
Trust, is transforming the lives of patients who take
Anticoagulant medicines are most commonly prescribed for people
who have had a condition caused by a blood clot, such as deep vein
thrombosis or pulmonary embolism. It may also be used by people who
have had a heart attack or a condition such as atrial fibrillation
that increases the risk of a blood clot developing.
Over 350 people across the county now monitor their INR -
international normalised ratio, a measure of how quickly blood
clots - from home.
They no longer need to attend clinic, sometimes once or twice a
week, to be monitored, meaning much less disruption to their daily
Patients receive training on how best to take a finger prick
blood sample, put it onto a test strip, and then place the test
strip in the monitor provided. The monitor gives a reading of
their INR. At a time convenient to them, the patient then
receives an automated phone call to report the INR reading, which
is shared with clinic staff digitally. A few hours later,
again at a time convenient to them, the patient receives a further
automated call, including any change to their Warfarin dose and the
date of their next screening.
Sister Tracy Murphy who helps manage the service, comments, "The
new system is optional although enthusiasm for it is very high
amongst patients, primarily because it is so much more convenient
for them. In addition, the training they receive gives
patients a greater understanding of what can affect their INR,
meaning they are finding it easier to remain within their ideal
therapeutic range. A major benefit of this stability is
a reduced risk of stroke."
Derek Jones, who lives in Middleton St George, and uses the
Warfarin digital self-testing service, is delighted with its
simplicity and convenience, saying, "I used to have to attend
clinic every two weeks, sometimes weekly. My INR readings
fluctuate unfortunately, meaning I need very regular monitoring and
the new system works around my life, rather than the other way
"I take my finger prick blood sample at 7.45am, just prior to
receiving an automated call during which I give the reading.
I get a further automated call at 6.00pm, after I return home from
work, giving me any dosage changes and the date of my next
reading. There is no disruption to my life now at all and I
have the security of knowing that the specialist nurses are always
at the end of the phone should I have concerns or feel the need to
arrange a clinic visit. A few weeks ago, I was even able to
submit my INR readings while on holiday in Minorca."
An INR that is too high carries an increased risk of bleeding
and the dose of Warfarin prescribed may need to be reduced.
Conversely, an INR that is too low may require an increased dose of
Warfarin to reduce the risk of clots still forming, or a blocked
Ian Dove, business development manager, says, "This new way of
monitoring has transformed the Warfarin service as a whole, as well
as the lives of our patients. Our specialist nurses are
still making the key decisions about dosage, but are doing so in a
much more efficient way, meaning more time can be focused on
supporting patients who most need it.
"During the next few months, improvements to the digital aspect
of the service, including a facility to report readings on-line,
will further enhance the patient experience. The current
system takes around three and a half minutes to determine dosage,
which will reduce to around 30 seconds.
"We're delighted the service was recently 'Highly Commended' in
the best collaboration across a patient pathway category at the
national Quality in Care Anticoagulation Awards, run by the Health
Pictured above: Lead Warfarin Nurse Tracy Murphy and
patient Derek Jones.
'I cannot commend the clinic enough. It is marvellous we
have this service at all and well done to you all.'
Patient, Coronary Heart Disease / Heart Failure Service, Shotley
Bridge Community Hospital