• Sales, support and service in a single telephone call (01480 862100)
• A swap out unit as standard for equipment being returned to the workshop for repair
• Use of a purpose-built transport case when you need to send a faulty instrument to the workshop
• An annual onsite service visit
• A pipette calibration and repair service
• All carriage costs included 

Our partner for this new service is Biohit – a company you may already be aware of through its excellent Pipette Doctor repair and calibration service.

The new service contracts will be available from 1^st October 2010.  Costs will be as follows:

For more information please call us on 01480 862100 or visit our website.

The videos are on YouTube and can be accessed from our web site here.

Jean Walton, lead anticoagulation practitioner for Lincolnshire PCT, chose the Thrombotest™/Thrombotrack™ method because test results correlated well with laboratory results from venous samples.  She also recently calculated that using this method had cost over £20,000 less to run compared with the cost of using a popular strip based system. 

In her article, Jean looks at the cost and patient benefits of using the Thrombotrack™ system in a community setting.  To read more please click here.

To find out more about the Thrombotrack™ system, please click here, or call us on 01480 862100 – we would be delighted to help.

With around 600,000 people in the UK currently taking warfarin⁽¹⁾ many NHS trusts are moving anticoagulation clinics into primary care. Hospital-based services are often over-subscribed and this is set to worsen with the growing number of patients taking oral anticoagulation therapies (OATs), such as warfarin.

Patients are normally prescribed warfarin to help prevent blood clots from forming as the result of a number of conditions including; atrial fibrillation, artificial heart valve or deep vein thrombosis (DVT). It is vitally important that health care professionals monitor the blood clotting time when patients are taking warfarin to ensure the correct dosage is administered. This blood clotting time is normally referred to as the INR level (International Normalised Ratio). The INR test will need to be regularly performed to ensure no alterations are needed to the prescribed dosage. 

When Jean Walton, formerly a lead anticoagulation practitioner for Lincolnshire PCT, was given the opportunity by GPs in the Lincolnshire area to set up anticoagulation services at their surgeries, she decided to take the leading role in coordinating this process. In this article Jean details her story and outlines the success of her service explaining how using coagulometers in primary care can not only save money, but vastly improve patient care in the community.

“We set up our clinics in 2006, with the aim of helping to improve the care of patients in our area that were taking OATs, such as warfarin, and to take pressure off over-crowded hospital based services. I had previously worked in this hospital environment for a number of years and had experienced many busy clinics in secondary care.

“Within our service we decided to use a coagulometer called Thrombotrack™ (Axis-Shield UK) which we found correlated well with laboratory results from venous samples. Recently we calculated that using this system cost us £7,852.50 to perform 10,250 tests, whereas using another popular strip based system would have cost £28,495*. Performing an INR test on the Thrombotrack™ costs us as little as £0.77 per result, whereas doing the same test on the other system works out at £2.69 per test.

“However, not only are there these obvious cost benefits, there are also many patient advantages to be seen. Using this coagulometer allowed us to process results in the clinic rather than sending samples to the laboratory for testing. This meant we could provide a one-stop clinic for patients, enabling us to advise the warfarin dosage required at the same time as doing the actual test. This is obviously a huge benefit to patients who can discuss any concerns they have with us there and then. It also means that patients can be stabilised earlier and no longer have to attend follow-up appointments, which is obviously having a positive effect.

“With our services being situated in a holiday resort, many of the patients I see, because of changes in their diet and drinking habits whilst away from home, often have INR results outside of their recommended levels. Prior to having access to this point-of-care system, I spent a lot of time trying to track patients down on caravan parks to tell them that they needed to alter their warfarin dose. Having the Thrombotrack™ system has eliminated this as I can now advise patients on their results whilst I am with them. If a patient’s INR is too high this could lead to a risk of uncontrolled bleeding and if it is too low it may not provide adequate protection from clotting risks. Knowing these results gives patient’s peace of mind as they know the dosage they have been prescribed is accurate.

“Our team assessed what patients thought of this new service by conducting a small survey in the surrounding area. This revealed that patients were very happy with the clinic’s work. They liked receiving the individual consultations and seeing the same staff each time.”

The daily clinics cover an area of three practices in Skegness on different sites with a current patient load of 710. Conditions that are treated on an everyday basis include; cardiac problems, acute VTE, cardiac surgery and thromboprophylaxis.

(Ends)

Footnote:

⁽¹⁾ British Heart Foundation, November 2007: https://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=d3e3e26f-90e7-4360-9b4a-8b95c77946f2&version=-1&title=IS67+Warfarin&resource=IS67

 * including lancets, but excluding the instrument and controls, which would add to this total

For further information about Thrombotrack™ please visit www.axis-shielduk.com

There were some especially good speakers and presentations given throughout the day so we’re really pleased that the abstracts are now available online for anyone with an interest in coagulation: UK NEQAS NPT

Summary

• Although the INR system was introduced to avoid inter laboratory discrepancies, patient results can vary depending on which system or reagents are employed. This has been hi-lighted by some recent changes in laboratory reagents.

• No one INR reagent can be considered a “Gold Standard”.  We don’t know who is right, and these variations are reflected in the NEQAS results.

• Testing should be on one system only; patients should be discouraged from chopping and changing methods.

• Anticoagulant managers (laboratory, hospital or community based) should work with their clinical colleagues e.g. cardiologists, to ensure that patient pathways incorporate these potential differences.

• Producing a local calibration or moving to alternative reagent systems can provide greater consistency between different testing sites.

• Thrombin inhibitors are on their way, but won’t be suitable for everyone e.g. unlikely to be licensed for patients with replacement heart valves. In the next 10 year or so, patients left on warfarin will probably be the difficult to dose patients and the ones whose INR needs to be kept at 3.5 – 4.5.

 If you would like to discuss any of these issues further or if you are interested in attending a similar event in future then please contact us at Axis Shield.

Some NHS Trusts are already making the decision to move anticoagulation clinics into primary care. This article examines the challenges experienced from the perspective of a lead anticoagulation practitioner and a lead nurse in primary care.

Jean Walton is lead anticoagulation practitioner for Lincolnshire PCT and Beacon Practice, Skegness. She previously worked in hospital-based anticoagulation clinics for a number of years and has experienced many oversubscribed clinics in secondary care. “Patients often spend long periods waiting around. In addition, many require ambulance transport, which carries significant time and cost implications. Too frequently patients aren’t given enough time to discuss their fears or changes in medication with a healthcare professional.” Compounding these issues further is the increasing number of patients needing anticoagulation therapy, such as warfarin, having been identified by general screening recommended by national service frameworks.

New clinics
GPs in the Lincolnshire area were offered the opportunity to set-up anticoagulation clinics in their surgeries and Jean took a leading role in coordinating this process. For practice staff, introducing a new clinic presented several challenges.

Jean explains, “One important decision to be made was which coagulometer and dosage decision software to use. Thrombotrack (Axis-Shield UK), in conjunction with Thrombotest reagent, was always used in our hospital clinics and as a result we had ten years’ experience of using the instrument. I also liaised with biomedical scientists who recommended the Axis-Shield system over other coagulometers because it correlates well with laboratory results from venous samples. It also has the advantage that when community nurses take venous samples, they can be processed on Thrombotrack in the clinic rather than being sent to the laboratory, which means that results are available faster. This isn’t possible on all instruments.”

Another key consideration was the training of users of the equipment. Although testing and dosage calculations are automated, the underpinning knowledge is important for being able to interpret results. “In addition to supplying the Thrombotrack instruments, Axis-Shield UK also trained me as a trainer so I was able to cascade this knowledge to other users and attend their first clinics.”

Seeing results
Jean and team assessed patients’ reactions to the new service; a small survey conducted in Skegness revealed that patients were very happy with the new anticoagulation clinics. “They appreciate receiving individual consultations and seeing the same staff each time”, says Jean. At County Hospital Louth, a community hospital, venous samples were previously used for all patients. “The new clinic here has really taken off. Previously, patients were bled at the laboratory and then asked to wait in outpatients. Now it’s a really slick clinic and both staff and patients love it.

Theresa Hare is lead nurse at Munro Medical Centre in Spalding. When the United Lincolnshire Hospitals NHS Trust decided to move anticoagulation clinics into primary care, the Munro Medical Centre chose to establish an anticoagulation service, and did so in just five weeks. Theresa explains, “We were allocated 250 patients initially. This has already grown to around 350. Our first steps involved visiting neighbouring clinics in both GP practices and community hospitals to see how they were run. When it came to choosing instrumentation, our neighbours both used Thrombotrack and so we opted for standardisation enabling us to borrow supplies from each other and compare results, should we ever need to.”

“Our clinic is operated by eight people with no previous anticoagulation experience so the fact that Thrombotrack is so user-friendly was very important to us. In practice, the instrument has always run very well and the only time we have received results which were off-track were as a result of the INR being greater than 9. We have been very happy with the system we chose.

“While setting up the clinic we received a great deal of support from both Jean Walton and Axis-Shield UK. They both helped us to develop protocols based on their considerable experience and also contributed to our health and safety policies.”

Munro Medical Centre originally operated 5 morning clinics a week but that has already been reduced to three as patients have been stabilised and require fewer recalls. “Patients attending the clinics have told us there has been a massive improvement in the service they experience. The system works very well and we are able to allocate patients to specific 10 minute slots.

Successful experience
The experiences shared by Jean Walton and Theresa Hare show that anticoagulation clinics in primary care can be very successful and that patients appreciate receiving care in the community. Choosing experienced partners who will help support anticoagulation practitioners with training and advice has proved to be invaluable in getting the clinics established.

The Thrombotrack system
The Thrombotrack instruments are small, easy to use coagulometers that are well suited to performing INR tests in GP practices and community clinics. Coagulation is detected by a change in viscosity, which occurs upon clot formation.

 Actions that can make anticoagulant therapy safer: Alert and other information

 As speakers we are delighted to have Jean Walton from Beacon Medical Practice, Terrie Emson from the Lincoln Hospital Haemostasis Laboratory and Jan Macintosh of Axis-Shield, to discuss a number of topics relating to INR testing and warfarin management. For more details please contact us: INR@axis-shielduk.com

The meeting is free-of-charge and aimed at anyone who is using Thrombotrack for their INR clinics. The programme starts at 12:30pm and finishes at 4.00pm on the day and lunch will be provided.  The event will be informal to encourage questions and discussion.

 To reserve your place, please contact Gillian Widders at Axis-Shield UK on telephone number 01480 862100, by Friday, 11^th September 2009.  Places are strictly limited by the size of the conference room.