[1] This document describes the continuing development of a community-based anticoagulation and stroke prevention service in North Central London.
[2] The service has transitioned from a doctor-delivered hospital service to a more robust and expanding community-based service delivered by practice nurses, pharmacists, and GPs supported by an electronic health record system.
[3] The focus is on enhancing stroke prevention for patients, education for practitioners, and strong clinical governance to ensure safe, high-quality care.
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Actshashi sinha
Due to side effects of Medicines and Medical Devices increasing day by day it is important to monitor the Adverse Events arising out of use of Medicines and Medical Devices. The Pharmacovigilance and Materiovigilance monitors adverse events arising our of usage of Drugs and Medical Devices respectively. This chapter also deals with Drugs and Cosmetics Act 1940 and their important provisions.
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Actshashi sinha
Due to side effects of Medicines and Medical Devices increasing day by day it is important to monitor the Adverse Events arising out of use of Medicines and Medical Devices. The Pharmacovigilance and Materiovigilance monitors adverse events arising our of usage of Drugs and Medical Devices respectively. This chapter also deals with Drugs and Cosmetics Act 1940 and their important provisions.
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Medical Devices , regulations and e health solutionsshashi sinha
Medical Devices are now regulated in India. It is essential to know about the Medical Devices Regulations and how it is being implemented. Must know for all the manufacturers, importers and Distributors of Medical Devices.
Managing Stroke risk in Atrial Fibrillation: Are we fulfilling our potential?
Presented by Mel Varvel - NHS Improving Quality and Marion Kerr - Insight Health Economics at National Association of Primary Care ‘Best Practice’ Conference in Birmingham, October 2013
GRASP-AF tool: Identifies patients with a history of atrial fibrillation
Searches for co-morbidities and calculates a CHADS2 (and now CHA2DS2-VASc) score
Searches for current medication- warfarin, aspirin or newer oral anticoagulant
Searches for recorded reasons for NOT treating with OAC
Gives a simple alert for those at high risk and not on warfarin or newer oral anticoagulant
Medical Records is a foremost important in the healthcare accreditation bodies like JCI,NABH are very adherent about its documentation,retention and confidentiality.
Medical Devices , regulations and e health solutionsshashi sinha
Medical Devices are now regulated in India. It is essential to know about the Medical Devices Regulations and how it is being implemented. Must know for all the manufacturers, importers and Distributors of Medical Devices.
Managing Stroke risk in Atrial Fibrillation: Are we fulfilling our potential?
Presented by Mel Varvel - NHS Improving Quality and Marion Kerr - Insight Health Economics at National Association of Primary Care ‘Best Practice’ Conference in Birmingham, October 2013
GRASP-AF tool: Identifies patients with a history of atrial fibrillation
Searches for co-morbidities and calculates a CHADS2 (and now CHA2DS2-VASc) score
Searches for current medication- warfarin, aspirin or newer oral anticoagulant
Searches for recorded reasons for NOT treating with OAC
Gives a simple alert for those at high risk and not on warfarin or newer oral anticoagulant
- Describe the basic characteristics of new oral anticoagulants (OACs)
- Recognize potential candidates for new anticoagulants for atrial fibrillation and treatment of venous thrombosis
ASA/AHA 2014 guidelines for the Primary Prevention of Stroke
Hypertension and dyslipidemia impact on stroke development and prevention
SPRINT and HOPE-3
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
Pathology Optimisation in Chronic Blood Disease MonitoringAndrew O'Hara
Richard Croker shows how an innovative approach to service redesign can improve patient outcomes at pace and scale through the safe and effective use of testing at NHS Northern, Eastern and Western Devon CCG.
Aaron Brizell - ECO 17: Transforming care through digital healthInnovation Agency
Presentation by Aaron Brizell, Population Health Programme Manager, Wirral University Teaching Hospital NHS Foundation Trust: The benefits of system-wide population health and analytics at ECO 17: Transforming care through digital health on Tuesday 4 December at Lancaster University, Lancaster
TMLT risk management staff conduct on-site practice reviews to help physicians determine and address their medical liability risks. In 2016, risk managers reviewed more than 2,000 physician practices, and gave the following 10 recommendations most frequently.
Ομιλία – Παρουσίαση: Raymond Anderson, President Commonwealth Pharmaceutical Association and Member of the Pharmacovigilance Risk Assessment Committee (PRAC) at EMA
«Best Practices to inform citizens on Self-medication»
How to improve the practice of clinical pharmacy in Egypt?
A call to action presentation aiming at uniting practitioners to create a work force that can help change the future of the practice in Egypt.
Join, share, participate and invite others.
If interested, please, join our group here,
https://www.facebook.com/groups/307874012697956/
Ph. Mamdouh Ezz Samy
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
Nick Mays of the Policy Innovation Research Unit presents some conclusions from the early evaluation of the Integrated Care and Support Pioneers Programme.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
Thomas Woodcock, Improvement Science Fellow at Imperial College London, talks about the various measurement approaches and processes when working at large scale to assess care quality improvements.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
Paul Aylin, Co-Director of the Dr Foster Unit at Imperial College London, gives concrete examples of using a specific statistical model for monitoring care quality, cumulative sum (CUSUM).
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
David patterson: Continuing development of the community based anticoagulant and stroke prevention services
1. Continuing development of the
community based anticoagulant and stroke
prevention services
Progressing towards
A STROKE PREVENTION SERVICE (AF AND AC)
Transition from successful pilot services towards more robust and
expanding services
21 November 2011
Professor David Patterson, Professor Dipak Kalra,
Department of Cardiovascular Medicine and Pharmacy, Whittington Health
Centre for Health Informatics and Multiprofessional Education, University College London
2. Electronic Health Record (EHR)
Supporting clinical shared care across organisations
Building on ~20 years of European research
Conforms to the latest international standards
Robust medico-legal and confidentiality features
Standards for clinical knowledge capture enable meaningful clinician
developer interaction and rapid development
Implemented as a web based system
Incorporates decision support and alerts
Cardiovascular modules
•HeartBeat AC: anticoagulation - in live use
• HeartBeat HF: heart failure - ready for live use
• HeartBeat AF: atrial fibrillation - clinical engagement commencing
3. Clinical Governance report
Derived automatically from the EHR
Each site can run its own report at any time
All reports include anonymous service-wide comparisons
Reviewed at quarterly Clinical Governance Board meetings
4. North Central London Community Based
Anticoagulant and Stroke Prevention Services
PROGRESSING TOWARDS
A STROKE PREVENTION SERVICE (AF AND AC)
• Enhancing our ability to prevent patients developing strokes
• Progressed from a doctor delivered service in hospital toward an
increasingly community based service
• Delivered by practice nurses, community pharmacists and GPs,
supported by a state of the art information and advisory system
which uses an Electronic Health Record
• A strong focus on education and on clinical governance
• Our services have been shown to be safe and very well received
by the patients, by the commissioners of health services and by the
community staff
5. Forgetful, elderly person with diabetes, atrial
fibrillation, heart failure and mild aortic valve
stenosis, who lives alone in
poor housing and requires anticoagulation
• Multiple chronic conditions
• Multiprofessional care
• Shared information needs - across boundaries
• Interface with other organisations:
– Social services
– Housing
– Voluntary sector
– Ambulance/car services
– Primary/secondary/tertiary care
6. Development of advisory systems for warfarin
dose and follow-up interval guidance
• CONTEXT - 1
• In latter part of 20th Century – warfarin management
was a doctor delivered service in hospital environment
• Regarded as dull and unchallenging
• Often performed by the most junior doctor with little
experience of anticoagulation
7. Development of advisory systems for warfarin
dose and follow-up interval guidance
• CONTEXT - 2
• And yet
• Developing realisation that warfarin was potentially a
dangerous drug influenced in its effects by many
factors such as diet and use of other drugs
• Increasing evidence that there was an unacceptably
high morbidity and death directly related to warfarin
• Very poor communication between health
professionals when introducing a new drug or starting
new treatment for a patient
8. [1] Evaluation of a decision support system for initiation
and control of oral anticoagulation in a randomised trial
[2] Validation of an algorithm for oral anticoagulant dosing
and appointment scheduling
• [1] The computerised decision support system was safe and effective
• It improved the quality of initiation and control of warfarin by trainee
doctors
• [2] The algorithm performs better than inexperienced clinicians and
as well as experienced clinicians for the non-difficult patients
• Algorithm better at recognising the more difficult case than the non-
expert (ie to see doctor)
• Analysis of combination of dose and interval recommendation showed
remarkable similarity between experts and algorithm
10. 400
0 therapeutic
range
3000
2000
1000
0
1 00 1.50 2.00 2.50 3.00 3.50 4.00 4.55 5.00 5.50
INR value - patients with therapeutic range 2.0 - 3.0
Total 18881 (full tail at high values not shown)
11. All therapeutic ranges
100
Above range
80
60
Percentage In therapeutic
of INR results range
40
20
Below range
0
0 36
Months into anticoagulation therapy
14. ANTICOAGULANT AND STROKE
PREVENTION SERVICES at
HOSPITALS AT: WHITTINGTON AND NORTH MIDDLESEX HOSPITALS
PHARMACIES AT: HIGHBURY BARN, N5 BOOTS (WOOD GREEN), N17
POLYCLINIC AT: ENFIELD (1 GP CENTRE/POLYCLINIC), N9
GP PRACTICES AT:
HIGHGATE GROUP PRACTICE, N6 DUKES AVENUE, N8
SOMERSET GARDENS, N15 TYNEMOUTH ROAD, N17
MORRIS HOUSE, N22 GOWER STREET, WC1
HAMPSTEAD GROUP PRACTICE, NW3 JAMES WIGG PRACTICE NW5
MUSEUM PRACTICE WC1B KEATS GROUP PRACICE NW3
PARK END SURGERY NW3 PARLIAMENT HILL SURGERY NW5
REGENTS PARK MEDICAL CENTRE NW1 ROSSLYN HILL SURGERY NW3
BRONDESBURY MEDICAL CENTRE NW6 AMPTHILL SQUARE NW1
ADELAIDE ROAD, NW5 ROMAN WAY MEDICAL CENTRE, N7
RITCHIE STREE GROUP PRACTICE, N AMWELL GROUP PRCTICE, WC1
ELIZABETH AVENUE, N1 RISE HEALTH CENTRE, N19
KILLICK STREET, N1
HOSPITAL OUTREACH SERVICES TO:
GOODINGE HEALTH CENTRE, N7 RIVER PLACE HEALTH CENTRES, N1
TORRINGTON SPEEDWELL HEALTH CENTRE, N12 EDGWARE COMMUNITY HOSPITAL, HA8
STANDARD CLINICAL OPERATING PROCEDURE
15. CLINICAL GOVERNANCE BOARD
Anticoagulation & Stroke Prevention Service
• MEMBERSHIP
• PATIENTS
• HOSPITAL CONSULTANTS – CARDIOLOGY AND HAEMATOLOGY
• ANTICOAGULANT PRACTITIONER FROM EACH OF THE 5 PCTS (GP OR PRACTICE NURSE)
• ANTICOAGULANT PRACTITIONERS FROM HOSPITAL(S) OUTPATIENT SERVICE
• SENIOR PHARMACIST WITH EDUCATIONAL REMIT
• SENIOR PHARMACISTS WITH CLINICAL GOVERNANCE REMIT
• COMMISSIONER FROM EACH PCT
• CLINICAL LEAD FROM EACH PCT
• ACADEMIC HEALTH INFORMATIST
• ACADEMIC BEHAVIOURAL SCIENTIST AND STATISTICIAN
• ACADEMIC LEGAL AND EDUCATIONAL ADVISOR
• IM&T REPRESENTATIVE FROM WHITTINGTON HOSPITAL
16. Generic Ingredients of our integrated services
together with
Our package of support
• Education and training for practitioners
– Formally defined syllabus
– Training sessions including practical skills and use of the information system
– Formal assessment, required certification, periodic reassessment
• Clinical information system
– Electronic Health Record supporting clinical shared care across different organisations
– Disease management system - anticoagulation; heart failure; atrial fibrillation etc etc
– Clinical management advisory system
• Clinical support
– Direct contact with senior clinicians, able to access the same EHR from different sites
• Clinical governance
– Clinical standard operating procedures and site specific operating procedures
– Quality assurance processes and monitoring
– Review and comparison of outcomes
– Multidisciplinary clinical governance board
17. Comments from Patients
• Site 1
–Very satisfied with everything
–Always on time and always most helpful
–I can not fault anything. I only wish I did not have to come
–Nothing at this time
–Very very good
–Appointments always on time treatment well explained
–All your staff are excellent
–Very competent
• Site 2
–To continue this same way as at present
–I am very happy with the service given here, many people take up
this choice
–No Complaints at all
–All very satisfied
–I am very satisfied with the anticoagulant service
–Delighted with the service, I got to compliment you on your lovely
polite staff
18. Quality and safety principles of our integrated care
service
• the patient will receive monitoring care in the most convenient and
safe place for them
• the practitioner will be demonstrably well trained, up to date and able
to offer a high quality service
• the EHR of the patient will be available in a timely manner to all of
the practitioners caring for the patient, wherever located
• clinical governance arrangements will be implemented and learning
processes enhanced
• hospitals will continue to play key roles in clinical support, education
of staff, clinical governance and service development
• the patient or customer is central to the planning and delivery of
services
19. CLINICAL GOVERNANCE BOARD
Anticoagulation & Stroke Prevention Service
• MEASURES OF SATISFACTORY QUALITY AND SAFE PERFORMANCE
• PATIENT FEEDBACK/QUESTIONNAIRES FROM EACH PCT
• TRAINING, EDUCATION AND PERFORMANCE OF ANTICOAGULANT PRACTITIONERS
(OSCE AND RE-ACCREDITATION) FOR ALL PRACTITIONERS
• ANTICOAGULANT CONTROL (BY SITE -- BY WHOLE SERVICE – BY PCT --- BY
PRACTITIONER -- BY TIME - BY THERAPEUTIC RANGE ETC)
• INFORMATION GOVERNANCE (ACCESS CONTROL; SECURITY; BACKUP POLICIES)
• QUALITY CONTROL OF CLINICAL PREMISES - ANNUAL VISITS –
• QUALITY CONTROL OF EQUIPMENT – POCT EQUIPMENT AND NEW REGULATIONS –
SEEKING CPA ACCREDITATION FOR COMMUNITY SERVICE
• THE ANNUAL REVIEW OF PATIENT – NOW BEING PILOTED
• USE OF ROOT CAUSE ANALYSIS (RCA) AND COGNITIVE WORK ANALYSIS (CWA) IN
“NEAR MISSES” OR UNTOWARD INCIDENTS
• REAL TIME ANALYSIS OF PERFORMANCE
22. North Central London Integrated Care Model
Whittington Hospital
and its collaborating
Hospitals
Collaborative GP Practices
development Consultant-led and
of EHR Community Cardiology Pharmacies
systems Service
CHIME
(UCL)
The Consultant-led Community Cardiology Services
provides protocol-led and formally-evaluated
collaborative care, initially for anticoagulant and
cardiovascular diseases.