Presentations from the training session for detecting AF at The Hartree Centre on Tuesday 12 November.

1. Hello and welcome
Please help yourself to food and
refreshment.

2. Pharmacy-AF Pilot Project
Working group members
• NWC Innovation agency Project Manager, Associate Director Patient Safety: Dr Julia Reynolds
• GP CVD Clinical Lead, Knowsley CCG: Dr Adit Jain
• Joint Chief Officer Halton, St Helens & Knowsley Local Pharmaceutical Committee: Mrs Louise Gatley & Mrs Helen Murphy
• Senior Clinical Pharmacist & Chair of Pharmacy Local Professional Network NHS England: Mr Hassan Argomandkhah
• GP Pharmacist, Knowsley: Ms Jayne Brady
• NWC Innovation agency Project Manager, Patient Safety: Mrs Helen Beaumont-Kellner
• NWC Innovation agency, Quality Improvement Lead, Patient Safety: Michelle Coleiro
• Liverpool John Moores University, Readers: Dr Lisa Jones and Dr Hannah Timpson

3. Pharmacy-AF Pilot Stakeholders
Community and GP
pharmacist Joint working
Community & pathways
Community
pharmacists
GP practice
Pharmacist
PharmOutcomes
Knowsley
CCG
Halton
CCG
CCG, CVD groups
Stroke
prevention
Detect
&
Protect
NWC Innovation Agency New ways of workingEffective communication
AF
Collaborative
Alivecor
Kardia
LJMU
LPC/ LPN
Pharmacy
Patient
monitoring
&
connected
health
MyDiag
nostick
21/11/2019 Helen Beaumont-Kellner RN, BSc (hons), MClin Res 3
Happy
Hearts

4. Clinical AF Training
Dr Phil Jennings, Medical Director
@DrPhilJennings

5. Anatomy
Normal Electrophysiology
AF Electrophysiology
Clinical consequences
Diagnosis
Prevalence
Treatment

6. A
N
A
T
O
M
Y

7. E
L
E
C
T
R
O
P
H
Y
S
I
O
L
O
G
Y
Sino Atrial
Node
Atrio
Ventricular
Node

8. E
L
E
C
T
R
O
P
H
Y
S
I
O
L
O
G
Y
Atrio
Ventricular
Node

9. C
O
N
S
E
Q
U
E
N
C
E
S
Left Atrial
Appendage

10. C
O
N
S
E
Q
U
E
N
C
E
S

11. E
P
I
D
E
M
I
O
L
O
G
Y
AF Prevalence in Age Bands

12. E
P
I
D
E
M
I
O
L
O
G
Y
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Missing Patients 2015-16 QOF
Expected Prevalence – Number on QOF Register

13. T
R
E
A
T
M
E
N
T

14. Questions?

15. David Dewhurst – Patient & Public Involvement
Officer
@InnovationNWC

16. @InnovationNWC

17. @InnovationNWC
The Diagnostick is the device that will be installed for AF self-testing in the pharmacy setting. This is a class IIa
medical device designed in close collaboration with medical professionals to rapidly and effectively detect AF with
96% accuracy according to current research.
This device is designed to be straight forward to use and understand. It shows pulse rate through a simple flashing
LED and gives a straight forward result. The devices will also be installed on a stand with an information/advice
display to help members of the public perform the self-testing.
The device is simply held (like bicycle handlebars) for 60 seconds and gives one of 2 results, shown on the next
screen.
This device may be less suitable for individuals with grip-strength issues as it requires steady contact for the full 60
seconds and may not be able to complete a check if individuals are unable to maintain steady grip for that long.

18. @InnovationNWC
Hold here And here
Lights will progress along here. This takes 60 seconds.
No issues
detected
Possible AF or
other irregularity
detected. Follow
previous advice
and issue letter.

19. No further action needed.
Individual’s result will be double
checked with a second ECG
device as part of a one to one
consultation.

20. @InnovationNWC

21. Helen will now take us through the software used to pull use data from the MyDiagnostic device and
how to send this data to the GP.

22. @InnovationNWC

23. @InnovationNWC
The second device that will be used to check for AF is the AliveCor Kardia, the
specific model we use is the KardiaMobile.
The AliveCor links to a mobile device through an APP, which you may have already
installed on your tablets/phones. We recommend using an NHS email address to
register your account.
The APP can be found in the Google Play Store or iTunes Store, if you have not
already done so.
The AliveCor uses the screen of the mobile device to display the ECG trace as it
collects data, which can be emailed directly from the device using the email
address which you registered to the account.
The device will then give one of 3 results:

24. @InnovationNWC
• Normal
AF has not been detected at this time.
• Unclassified/Tachycardia/Bradycardia
The ‘Unclassified’ result will most often occur due to a break in contact with the device during the test but
can also be caused by excessively dry skin or other issue limiting contact/conductivity.
Tachycardia/Bradycardia should be treated in line with the pathway for these conditions.
• Possible Atrial Fibrillation
If the device indicates Possible Atrial Fibrilation, the individual’s data should be entered into the system
and sent to their GP along with a copy of their ECG trace for further investigation. Those the
KardiaMobile is an accurate device, it should not be used alone as the basis of a diagnosis.

25. @InnovationNWC

26. Pharmacy Pathway
Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside),
NHS England

27. 21/11/2019 Helen Beaumont-Kellner RN, BSc (hons), MClin Res 27

29. Break

30. Project Measures
Michelle Coleiro, Improvement Lead, Innovation Agency

31. Pharmacy-AF: Outcomes & measures
Outcomes/objectives Measure Data Source Who? Frequency
Test the role of
Community Pharmacists
in detecting AF
No of MyDiagnostick tests completed MyDiagnostick
download
Comm Pharm 3 monthly
No Kardia traces done PharmOutcomes Comm Pharm 1 monthly
No ‘possible AF’ Kardia traces PharmOutcomes Comm Pharm 1 monthly
Patients with confirmed AF signposted to the Community
Pharmacy
EMIS search Clin Pharm 1 monthly
Test the role of
Community Pharmacists
in the management of
newly diagnosed AF
patients
No patients consented onto the pilot project PharmOutcomes Comm Pharm 1 monthly
No visits to the pharmacy per patient PharmOutcomes Comm Pharm 1 monthly
No of pharmacy services signposted to e.g. smoking
cessation
PharmOutcomes Comm Pharm 1 monthly
No of patients engaged with text messaging PharmOutcomes Comm Pharm 1 monthly
Patient compliance: Q1: Is patient compliance good? If no,
Q2: Cause of poor compliance Q3: Action taken to improve
compliance
PharmOutcomes Comm Pharm 1 monthly
Patient feedback: Q1 Are you finding this service helpful?
(1-5) Q2: What other additional support do you suggest?
PharmOutcomes Comm Pharm
(plus external)
1 monthly
Test joint working
practices between
Community and Clinical
Pharmacists
Community Pharmacist and Clinical Pharmacist feedback Qualitative interview External 12 and 24
months

32. PharmOutcomes and payments
Louise Gatley, Joint Chief Officer Halton, St
Helens & Knowsley LPC

33. Questions & discussion