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Local hospitals lead the way in Warfarin home monitoring

INRA new digital health screening service introduced by County Durham & Darlington NHS Foundation Trust, is transforming the lives of patients who take anticoagulant, Warfarin.

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 lives.

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 around.

"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 blood vessel.

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 Service Journal."

Pictured above: Lead Warfarin Nurse Tracy Murphy and patient Derek Jones.

'As I was very, very nervous, I must have been the worst patient ever and they were brilliant with me and I can't thank them enough - could you please pass on my sincere thanks.'

Patient, Hysteroscopy Unit, Chester-le-Street Community Hospital