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New system sought to address deficiencies in anticoagulation clinics

By Paul Mulholland - 14th Mar 2022

Gaps in the current processes at the anticoagulation clinics in Naas General Hospital and Connolly Hospital have prompted a tender for a new clinical information system, the Medical Independent can report. 

According to tender documents, the numbers of patients attending the anticoagulation clinic at Naas General Hospital has increased “threefold” over the last 10 years. 

In addition, the European Working Time Directive has resulted in “decreased availability” of doctors to attend the clinic. 

The tender stated that this has led to the consideration of using other trained healthcare professionals, supported by appropriate protocols, to help operate the service as occurs at other units in Ireland and abroad. 

“The manual paper-based system currently in place is very labour intensive for nursing and secretarial staff,” according to tender documents. 

“This places a significant burden on the hospital’s anticoagulation service….Audits of the current system have identified quality gaps. There is no central electronic storage of patient demographics, blood test results, anticoagulation medication (warfarin or equivalent), dosing decisions or disease register for patients on anticoagulation medication (warfarin or equivalent).” 

The anticoagulation clinic is held five days a week. It is physically located outside of the hospital and is based on the ground floor of the Vista Primary Care Centre, Ballymore Eustace Road, Naas. It is a nurse-managed service with clinical governance provided by general medical and haematology consultants. 

There are approximately 250 patients per week attending the clinic and 100 new patients joining per year. 

The tender for the new system is initially for Naas General Hospital, then for Connolly Hospital, with the option to extend to other hospitals. 

The Connolly Hospital anticoagulation clinic is held four days a week and is run by medical NCHDs and nurses with clinical governance provided by the cardiology consultants. 

On average 750 patients attend the service per month with over 8,500 patients seen each year since 2019. 

“The current manual paper-based system is very labour intensive for medics, nursing and secretarial staff,” outlined tender documents. 

“Patient information is held on a roller-deck and dosing information [is] manually adjusted and recorded. As such, the process is highly manual and the data is subject to confidentiality, integrity and availability risks. The introduction of IT systems to facilitate the management of outpatient anticoagulation in other HSE sites has been demonstrated to improve patient safety, be cost-effective by reducing patient admissions, increase clinic efficiency and provide ongoing auditable data to ensure key performance indicators are maintained. 

“Equally an electronic system would reduce the dependency of NCHDs for the service and allow them to spend more time in other areas in the hospital, ie, wards and outpatient clinics.” 

The new system must provide an integrated computerised decision support system, which will interface with the hospital’s patient administration system and laboratory information system. 

The deadline for a response to the tender is 23 March. 

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