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PATIENT-CENTRED CARE IN ATRIAL FIBRILLATION: AN INTEGRATED MANAGEMENT APPROACH (submitted in 2019)

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European Statement

Patient Safety and Quality Assurance

Author(s)

virginia Silvari, Suzanne McCarthy , Gerry Allen

Why was it done?

Before its establishment, patients were referred by primary and secondary care physicians to a general cardiology clinic, often resulting in delay of the initial assessment and/or commencement of treatment for AF by the ANP. The HP had no involvement in this care pathway. The AF clinic has shortened the referral pathway for patients; physicians now refer patients directly to the clinic. The HP is responsible for medication optimisation; counselling and education whilst clinicians can focus on clinical examinations, diagnostics and analysis of tests results.

What was done?

The atrial fibrillation (AF) clinic was established in a tertiary referral hospital. The clinic is led by a hospital pharmacist (HP), with expertise in cardiology and anticoagulation, and an advanced nurse practitioner (ANP) specialised in electrophysiology. Cardiologists’ input is available when required. In line with AF guidelines of the European Society of Cardiology (ESC), patients attending the clinic receive full stroke risk assessment and are presented with different treatment options by the Multidisciplinary Team (MDT). These options include heart rate/ rhythm control and stroke prevention and where appropriate DC-cardioversion. Patient’s preferences guide management of the treatment.

How was it done?

Stakeholder engagement was essential in establishing the clinic and planning meetings were used to ensure seamless delivery of the service. Analysis of the process showed that the critical path (bottleneck) was access to diagnostics on the same day of attendance of the patient to the clinic. Therefore, the clinic was established on a day where the cardiac-physiology department had sufficient resources to accommodate the clinic. It was also necessary to ensure allocated time for the ANP and HP to deliver the service.

What has been achieved?

The HP has improved patient safety by conducting medication reviews, in particular optimisation of anticoagulants according to patients’ preferences (warfarin versus direct oral anticoagulants) and their characteristics such as renal functions, body weight and age. HP also provides to the patients a one-to-one counselling session on their medications (focus on anticoagulants), adherence, drug interactions and side effects.

What next?

Having seen the benefits of this AF Clinic and the holistic service it delivers, it is recommended that hospitals establish an AF clinic to provide optimum treatment and prevent AF-related complications.

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