“To Self Test or not to Self Test
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“To Self Test or not to Self Test – That is the Darzi Question”. Possessing or acting with the desire to do noble and romantic deeds, without thought of realism and practicality. Why did we do it?. Patient pressure Darzi Improving technology It seemed the right thing to do.

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“To Self Test or not to Self Test

– That is the Darzi Question”

Possessing or acting with the desire

to do noble and romantic deeds, without thought of realism and practicality

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Why did we do it?

  • Patient pressure

  • Darzi

  • Improving technology

  • It seemed the right thing to do

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How did we get there?

  • Full management review of the situation

  • Benefit analysis

  • Beg steal and borrow ideas

    don’t re-invent the wheel…

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The Boring Management stuff – or how we justified it

  • PEST Analysis

  • Stakeholder analysis

  • Force Field Analysis

  • LEAN Systems

P olitical e conomic s ocial t echnological l.jpg
Political Economic Social Technological

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  • “Those looking at planned care found more care

  • could, and should, be provided closer to people’s

  • homes, with greater use of technology, and

  • outpatient care not always meaning a trip to hospital.”

  • Darzi’s report (Darzi, 2008, p. 18)

    • Innovation Funding from the SHA is based on any project showing

  • “more for less”

    • Adoption and spread of new and innovative ways of working

    • New and improved processes

    • Improved patient pathways or procedures

    • New models of care

    • The shift of services into more cost effective settings

    • Technologies that improve the quality and productivity of care

    • Project/programme costs to support the delivery of the funded initiative”

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    • “The credit crunch” has left the UK government with borrowings in excess of £159.2 billion in the 2009 -2010 tax year (ONS, 2009)

    • The expenditure on the NHS was shown to double between the financial period 1998 -1999 and 2000 -2001

    • current estimated cost of admitting a patient to a hospital ward is in excess of £1200.00 (DOH, 2008)

    • The cost endured by patients: transport, fuel or public transport, parking fees , lost time at work.

    • “One quarter of families use grandparental childcare each week with this care valued at £3.9billion.” (Grandparents, 2008, p. 2)

    • meter cost in the region of £400.00

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    • The number of younger patients taking oral anticoagulants is increasing - fit therapy into ever changing lifestyles

    • Shop workers are required to provide 24 hour shopping so why not healthcare

    • Demand for flexibility particularly in the retired population is the dramatic increase in wintering abroad

    • Increased expectations via

      the media:

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    • DAWN computer aided dosing software

    • Digital messaging

    • Short Messaging Service (SMS)

    • The (INR) testing meters are now a mature and well tested technology allowing for their safe use by patients with good correlation to laboratory testing (PASA, 2008).

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    Current State

    Future State


    Force Field Analysis

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    What did the Management Analysis Prove

    It’s a bit better than guessing

    Sounds like we should

    Go for it

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    Patient record


    Patient record


    Patient record


    INR into DAWN system

    Dose calculated and printed

    Does Dose need to be


    Updated Patient record


    Returned to Patient via Royal Mail

    What happened before!

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    • Improve Quality

      • Understand the needs and desires of the customer designing the processes to meet their expectations and requirements

    • Eliminate Waste

      • Waste is defined any process or part of a process which consumes any resource including time and space but does not add value to the process or outcome.

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    INR into DAWN system

    Dose calculated and returned by SMS

    Return Cumulative Patient Record

    via Royal Mail

    What Did We Want to Happen

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    INR into DAWN system

    Dose calculated and returned verbally by phone

    Return Cumulative Patient Record

    via Royal Mail

    What Did We Manage

    Dose calculated and returned by SMS

    £10,080.00 would buy an interface to

    provide SMS and Email return

    automatically along with next test


    Please make cheques payable to Jeff Walker.

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    How Does it Work

    • Initial contact

    • First appointment to discus contract and how system works

    • Patient gains GP agreement (or not)

    • Three further training appointments

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    Joan's Bit – the real work

    Introducing NPT at Midyorks

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    Why Self test ?

    • Reduce workload

    • Improve compliance

    • Sharing responsibility of care

    • Committed to provide a service

    • Listen to Users of that service

    • Cos Jeff says so!!

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    Patient Criteria

    • Long Term OAT patients

    • Over 18 years of age

    • Able to understand English or have access to an interpreter

    • Have the dexterity to use a device to test their INR

    • Agree to attend four sessions of training in the anticoagulant clinic

    • Have the support of their general practitioner to self test their INR

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    Key Differences

    • Positively motivated patients

    • Develop proactive approach to therapy

    • Continuous improvement and reduction of risk

    • Sharing responsibility of care

    • Ownership of equipment

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    The Contract

    • Patients responsibilities

      • Do as you’re told… (or else)

  • Lab responsibilities

    • Nothing changes really

  • GP responsibilities

    • Sign up that the patient is capable

    • No commitment to prescribe test strips

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    • Leaflet committee!!!!

    • Clinical governance

    • Cost of equipment

    • GP’s

    • Community Pharmacists

    • PCT

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    • Improve compliance

    • Develop partnership with staff

    • Patient satisfaction

    • Staff satisfaction

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    What Did We Achieve?

    • Compliments!!!!!!!

      • “… you have given me my life back”

      • “… at last someone understands my needs”

      • “I’m not worried about loosing my job now”

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    What Did We Achieve?

    • Better control

      • Anecdotally yes – audits to come (next years talk?)

    • Better relationship with patients

    • Patient satisfaction

      • Compliments….

    • Staff satisfaction

      • Due to relationship improvements much better

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    What did we learn?

    • Management tools only tell half the story

    • There will be resistance

    • Keep it small to start with

    • It’s hard work

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    Was it worth it?

    • Absolutely