Patients should receive appropriate verbal and written information at the start of therapy and when necessary throughout the course of treatment. Past npsa alerts and guidance remain available on the archived website but please use these materials with caution. The yellow book i went to a training evening and came back convinced i should be asking to see the book each time and making my own judgement on the acceptable frequency of testing and confirming suitable range. Guidelines for the management of common medical emergencies and for the use of antimicrobial drugs have been used in many of the local hospitals. Safe use of warfarin in primary care health and social care board. What you need to know about warfarin cpd vol 287 3 september 2011. Details of our current reporting and alerting functions can be found below. Do not binge drink on holidays and try to maintain your usual diet. A healthcare professional will go through this book with you, explain what. Speak to your gp or anticoagulant clinic if you become pregnant or are planning to try for a baby while taking anticoagulants.
Michelle cerrato education and training pharmacist. Yellow books for warfarin i dont think the advice has changed. Cha2ds2vasc score of 2 or above and considering anticoagulation for men with a cha2ds2vasc score of 1, taking bleeding risk into account. Your doctor may want you to avoid any activity or sport that may result in a serious fall or injury such as contact sports. Dr matt oldfield, dr shahid valley, andrew mitchell, alexandra dunkerley. The principles within this are still applicable to. Some gps have started doing their own inrs and dont think it is necessary to provide the patient with a yellow book, and if you refer them to the npsa guidance, they have never heard of the npsa.
Following a national patient safety agency npsa alert in march 2007, a multidisciplinary group was established, involving haematology, pharmacy, nursing, pathology and it staff, to establish and take forward a strategy to improve patient safety in the outpatient inr clinic. Overall, warfarin reduces the risk of stroke by nearly twothirds. All patients should have a yellow anticoagulation book with an appointment to be. The national patient safety agency npsa advises that compliance aids may. The british committee for standards in haematology bcsh published its third edition of guidelines on oral anticoagulation in 1998 british committee for standards in haematology, 1998 with an update in 2006 baglin et al, 2006. The npsa has addressed anticoagulation management in order to. Therapeutic anticoagulation guideline nov15 whittington hospital. The yellow book sometimes in a busy pharmacy it is not practical to ask each and every patient on warfarin if they have there yellow book, and what is their inr, do they have regular tests, etc. The target inr range for each patient was specified by the referring clinician and double checked by the pharmacist against recommended targets for each indication. A baseline study of anticoagulant management in uk hospitals. Ensure that patients on anticoagulant therapy have received appropriate verbal and written information at the start of their therapy, and when necessary throughout their treatment in practice.
Yellow book patientheld information in need of revision and translation into other languages. Patients slowloaded as outpatients may be seen once a week. From april 2008, the national patient safety agency npsa has required community pharmacists to check that inr monitoring is carried out for all. Read more about things to consider when taking anticoagulants. Example of warfarin yellow book from npsa actions that can make.
The purpose of the yellow oral anticoagulation therapy pack information booklet, record book and alert card and to. National patient safety agency npsa, which is now part of nhs improvement, issued a patient safety alert about anticoagulants. In practice, this means making sure that patients have received a yellow book and ensuring that they or their. The kingston hospital guidelines follow a similar format with articles. When you start taking warfarin, you may be given a yellow book about anticoagulants. Practitioners managing oral anticoagulation with warfarin should meet the required competencies.
The npsa recommend that the record book should be presented by the. Anticoagulation management a guidebook for pharmacists. The yellow book also contains important information about the patients target inr range and a list of all the patients previous inr results, which is essential to ensuring good inr control. Safer anticoagulation by reengineering out patient.
What you need to know about warfarin pharmaceutical journal. Keep separate clinical notes including inr results and dosage. The oral anticoagulant therapy yellow booklet must be completed with recent doses and inr results. Moving anticoagulation initiation and monitoring services into the community. The target inr range for each patient was specified by the referring clinician and double checked by the pharmacist against recommended targets for each. Most anticoagulant medicines arent suitable for pregnant women.
Yellow card scheme go through the information booklet with the patientcarer. Complete the bshnpsa yellow oral anticoagulant therapy card figure 2 and dosage record or other appropriate written information and give this to the patient. Practical training guide for pharmacists, assisting them to care for and manage patients receiving anticoagulation therapy across pharmacy practice settings. Anticoagulant patient safety alert advice for social care providers.
If any information exists notes, records etc use this to. Nurse ensures good counselling given appropriate to patients understanding, using a check list. Npsa alert recommends that before dispensing, community pharmacists should be assured that the patient is being monitored regularly and the inr is at a safe level patient information key points for education of newly diagnosed patients 2. Staff trained by pharmacist as and when there is an ac patient. Date of the next inr test and contact numbers for advice should be recorded. Npsa alerts npsa survey on anticoagulation march 2010 the national patient safety agency npsa is keen to understand how patient safety alert 18 actions that can make anticoagulation safer can be further supported. Supply each patient with an anticoagulation book and ensure they fully understand the contents. New oral anticoagulants apixaban, dabigatran and rivaroxaban. Safer prescribing workbook section 3 high risk drugs written by. Inflexible medicines presentations and arrangements in care homes to. The pharmacy department will supply the yellow book to.
The directions on the label clearly should be stated take as directed as per inr. The national patient safety agency npsa website has now been archived. Npsa survey on anticoagulation the national patient safety agency npsa is keen to understand how patient safety alert 18 actions that can make anticoagulation safer can be further supported. The national patient safety agency npsa issued a safer practice notice in march 2007. In 2007 the national patient safety agency npsa issued patient safety alert 18 which contained a set of recommendations aimed at increasing the safety of warfarin dosing in section 8 the guidelines state. Yellow ac book is paper clipped to the drug chart for any patient on ac.
The npsa has commissioned kings college to undertake research on this. The national patient safety agency npsa has identified oral anticoagulants and heparin as major causes of adverse events and hospital admission. Antiplatets and anticoagulants therapy can be combined e. Yellow anticoagulation npsa book read through with patient patients representative 5. Yellow anticoagulant treatment booklets eversion advice. Warfarin counselling frequently features in osce exams and therefore its something you need definitely need to practice, ensuring you are aware of the salient points you need to communicate to a patient during a consultation. Check out the warfarin counselling osce mark scheme here. Moving anticoagulation initiation and monitoring services. Anticoagulants west suffolk clinical commissioning group. She was given a yellow book and booked into the anticoagulation clinic for the following week but she was not informed about the appointment nor was it documented it in her yellow book. These recommendations on safety indicators compliment those guidelines. The national patient safety agency npsa is recommending that nhs. The national patient safety agency npsa has outlined the major risks associated with anticoagulant therapy and sought to establish safer practice 1. Check patient has yellow book and that yellow book has been fully completed by doctor or pharmacist details on treatment card sent to.
The national nhs patient safety team is now part of nhs improvement. Patient and carer groups have informed the npsa that warfarin regimens with the following characteristics. Best practices and real world examples of pharmacists in anticoagulation management highlight the growing role of pharmacists in this area. Prescribing and monitoring of warfarin cambridgeshire and. A clear and safe algorithm, from admission to discharge. Warfarin is classified as a critical medicine as defined by the national patient safety agency. Warfarin should be used in accordance with the requirements of the npsa alert. Npsa alert on anticoagulation was issued but before discussions had resulted in action, and it serves. A baseline study of anticoagulant management in uk hospitals annette lankshear,1 jane harden,2 karin lowson3.
Safer prescribing workbook section 3 high risk drugs. Anticoagulation oral last revised in january 2020 next planned. Yellow book, patient held information, in need of revision and translation into other languages. As the inr begins to stabilise, the frequency can gradually decrease.
Learning from patient safety incidents nhs improvement. The yellow record book used by anticoagulant clinics can be used by the patient to record inr. The yellow npsa oral anticoagulant therapy information pack may be used to support patient education in patients prescribed warfarin. Anticoagulant patient safety alert advice for social care. Gp with special interest in anticoagulation primary care.