MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

LANCASHIRE MERSEYSIDE & CHESHIRE PRISON PEER EDUCATOR JOB
MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL
MERSEYSIDE YOUTH ASSOCIATION LIMITED JOB DESCRIPTION POST FACILITIES COORDINATOR

Merseyside & Cheshire Palliative Care Network Audit Group

Supra-Regional Audit of Anticoagulation in Palliative Care

Dear Colleague,

As part of the Merseyside & Cheshire Palliative Care Network Audit Group programme, we are performing an audit of guidelines for the use of anticoagulation medication in palliative care.

We would be grateful for your participation in this audit by completing the enclosed data collection form in relation to palliative care patients receiving anticoagulation medication in your setting.

In a period between now and Friday 12^th February 2010, please complete a data collection form for each patient receiving any type of anticoagulation, up to a maximum of 10 patients per setting.

Please return completed forms to:

Dr Richard Latten, Marie Curie Hospice Liverpool, Speke Road, Woolton, Liverpool, L25 8QA; Email: [email protected]

Outcomes from the audit will be presented at the regional audit meeting on 4^th March 2010 at Marie Curie Hospice Liverpool.

Thank you for taking time to help with this audit.

Anticoagulation Audit Group:

Dr Helen Emms - Consultant in Palliative Medicine, St John’s Hospice

Dr Carolyn Watt - Consultant in Palliative Medicine, Lancaster

Dr Leslie Johnny - STR in Palliative Medicine, St John’s Hospice

Dr Richard Latten - SpR in Palliative Medicine, Royal Liverpool Hospital &

Marie Curie Hospice Liverpool

Denise Farrance - Team Leader, St John’s Hospice

Sue Croft - Community Macmillan Palliative Care Nurse Specialist

M MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL erseyside & Cheshire Palliative Care Network Audit Group

Supra-Regional Audit of Anticoagulation in Palliative Care

Data Collection Sheet

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Basic Information

Please select your setting: Hospital Hospice Community

Please select your role: Medical Nursing Other (please specify): _________

Please select your location:

Halton Isle of Man Lancaster Other (please specify): _____________

Aintree Southport Liverpool

Wirral West Cheshire St Helens / Knowsley

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Demographic Information

Patient age: 18-30 31-40 41-50 51-60 61-70 71-80 81+

Patient gender: Male Female

Diagnosis: _________________ Metastases : _________________

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

General Anticoagulation Information

Which speciality initiated anticoagulation?

Palliative care Other (please specify): ___________ Don’t Know

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

When was anticoagulation initiated?

During this care episode Already taking anti-coagulation

How long has the patient been on anticoagulation therapy: _______________

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Is the indication for anticoagulation documented? Yes No

Please state indication for anticoagulation: ___________

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Is the intended duration of treatment documented? Yes No

Please state intended duration of anticoagulation: __________

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Which anticoagulation was commenced?

Oral Anticoagulation	Parenteral Anticoagulation (Heparin)
Warfarin	Enoxaparin (Clexane^®)
Other (please specify):	Dalteparin (Fragmin^®)
Other (please specify):	Tinzaparin (Innohep^®)
	Other (please specify):

F MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL or patients receiving Heparin anticoagulation:

Please state whether the following information is documented:

Full Blood Count:

Pre-treatment? Yes No Platelet count: _____

1 week following initiation? Yes No Platelet count: _____

Subsequent 4 weekly following initiation? Yes No Platelet count: _____

Renal Function:

Pre-treatment? Yes No Creatinine: _____

Patient weight:

Pre-treatment? Yes No Weight(kg): _____

Subsequent assessments? Yes No Weight(kg): _____

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

For patients receiving Warfarin anticoagulation:

Is the target INR documented? Yes No INR: _____

Is the most recent INR documented? Yes No INR: _____

Is the current warfarin dose documented? Yes No Dose: _____

Was the patient issued a standard anticoagulation booklet? Yes No

Was the clinician responsible for INR monitoring and patient follow up documented in the case notes? Yes No

MERSEYSIDE & CHESHIRE PALLIATIVE CARE NETWORK AUDIT GROUP SUPRAREGIONAL

Venous Thromboembolism Prophylaxis:

Does your unit / care setting have a policy regarding anticoagulation for venous thromboembolism prophylaxis in palliative care patients?

Yes No Don’t Know

If ‘Yes’ please attach a copy of policy.

Thank you for your help in participating with this audit. Outcomes from the audit will be presented at the regional audit meeting on 4^th March 2010 at Marie Curie Hospice Liverpool.

Tags: audit group, regional audit, merseyside, supraregional, palliative, network, cheshire, audit, group