What are we doing to prevent strokes?July 15, 2017
A new online tool will help prevent strokes and save lives
This week together with our partners we launched the Pan-London Atrial Fibrillation (AF) toolkit. The online toolkit is the culmination of a collaboration between the three London Academic Health Science Networks (AHSNs) and the London Clinical Network (LCN).
Visualised in 2016, it is targeted at commissioners and providers who want to find more people with AF (Detect), Treat more people with AF (Protect) and improve the outcomes of those people receiving treatment (Perfect). The toolkit focuses on each of these three areas and is laid out in a logical order, first setting the scene with an introduction from Tony Rudd (National Clinical Director for Stroke, NHS England) and Matt Kearney (National Clinical director for Cardiovascular Disease Prevention, NHS England) highlighting the unmet need for appropriate anticoagulation and improved detection of AF.
Within each of the three domains there are three “opportunities for improvement” designed to stimulate ideas and focus efforts. These contain case studies, resources and best practice examples which provide guidance on how to replicate. With all quality improvement it is vital for teams to understand their ‘current state’ before embarking on the future. The AF improvement cycle (on page 7) encourages teams to consider the quality and performance of their service compared to national standards and highlights the need for them to understand and interpret their own service level data. The AF improvement cycle is a complete and concise methodology which has been developed through the understanding of the critical success factors needed to undertake AF improvement work. It can be applied to any of the three domains and opportunities for improvement.
Complementing the AF improvement cycle is a series of infographics for each London CCG which clearly and pictorially presents data on prevalence, anticoagulation rates, those known to be at risk of stroke and those who have had a stroke in the past year. These have already proved very powerful in engaging interest and understanding a starting point. For those teams outside of London, or for data more focused on each domain (Detect, Protect and Correct) there is a useful table of data sources laid out within each of these.
Supporting all of this is the AF business case model. Designed by Public Health England and the AHSNs this tool uses publically reported data of AF to help organisations identify areas for improvement in the identification management of AF. It will also quantify the cost and savings associated with addressing these opportunities.
Within detect there is a focus on AF Awareness campaigns, the importance of manual pulse rhythm checks and AF detection devices. This includes the Health Innovation Network’s AF detection device review, a detailed report which defines the current technology and software designs available to enhance AF detection. It contains examples of how to use these devices and improve actual prevalence in a variety of settings.
Within protect there is focus on how to improve anticoagulation, Initiating anticoagulation in community settings, correcting heart rhythm and rate where necessary.
Perfect encourages high quality anticoagulation services which provide patient education, a range of treatment options and support of self-monitoring. It contains the ‘Excellence in Anticoagulation Care’ document from the London Clinical Network – a guide for commissioners and service providers to help deliver high quality anticoagulation services.
A pathway for service review is contained in this section including a checklist to assist commissioners in benchmarking their anticoagulation service or create a service specification.
There are also educational resources for patients and staff n to support self-management and self-monitoring of International Normalisation Ratio (INR) for those prescribed Warfarin.
Designed to dispel the common myths and misconceptions encountered when prescribing anticoagulation, by providing an evidenced based explanation.
I hope the toolkit will inform clinicians and commissioners in the design of local services to deliver the best patient care and optimum outcomes.
Download the toolkit here.