Quality statement 6 (developmental): Self‑monitoring of anticoagulation

Developmental quality statements set out an emergent area of cutting‑edge service delivery or technology currently found in a minority of providers and indicating outstanding performance. They will need specific, significant changes to be put in place, such as redesign of services or new equipment.

Developmental quality statement

Adults with atrial fibrillation on long‑term vitamin K antagonist therapy are supported to self‑manage with a coagulometer.

Rationale

Enabling adults with atrial fibrillation to self‑manage their coagulation using a coagulometer can help to optimise their anticoagulation treatment. As well as reducing the frequency of hospital or clinic visits, it can improve health outcomes such as risk of stroke and bleeding.

Quality measures

Structure

Evidence of local arrangements for adults with atrial fibrillation on long‑term vitamin K antagonist therapy to be supported to self‑manage with a coagulometer.

Data source: Local data collection.

Process

Proportion of adults with atrial fibrillation on long‑term vitamin K antagonist therapy who are supported to self‑manage with a coagulometer.

Numerator – the number in the denominator who are supported to self‑manage with a coagulometer.

Denominator – the number of adults with atrial fibrillation on long‑term vitamin K antagonist therapy.

Data source: Local data collection.

Outcome

a) Patient experience.

Data source: Local data collection.

b) Rates of adults on long‑term vitamin K antagonist therapy who self‑manage.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care services) make coagulometers for self‑monitoring available to adults with atrial fibrillation who are on long‑term vitamin K antagonist therapy, and ensure that support is available for their use.

Healthcare professionals offer coagulometers to adults with atrial fibrillation who are on long‑term vitamin K antagonist therapy so that they can self‑monitor their coagulation status, provided that they are willing and able to do so. Healthcare professionals also provide support for people using the coagulometers.

Commissioners (clinical commissioning groups) ensure that secondary care providers have coagulometers for self‑monitoring available and offer them to adults with atrial fibrillation who are on long‑term vitamin K antagonist therapy, and provide support for their use.

What the quality statement means for patients, service users and carers

Adults with atrial fibrillation who are taking a vitamin K antagonist over a long time are (if appropriate) offered a monitor they can use to help check how well the treatment is working, if they want to use the monitor and can do so. They are also given support by healthcare professionals to use the monitor.

Definitions of terms used in this quality statement

Coagulometer

Coagulometers monitor blood clotting in adults taking anticoagulants.

The CoaguChek XS system is recommended for self‑monitoring coagulation status in adults on long‑term vitamin K antagonist therapy who have atrial fibrillation if:

  • the person prefers this form of testing and

  • the person or their carer is both physically and cognitively able to self‑monitor effectively.

[Adapted from Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care coagulometers (the CoaguChek XS system) (2014, updated 2017) NICE diagnostics guidance 14, recommendation 1.1]

Support

Patients and carers should be trained in the effective use of the CoaguChek XS system and clinicians involved in their care should regularly review their ability to self‑monitor. Equipment for self‑monitoring should be regularly checked using reliable quality‑control procedures, and by testing patients' equipment against a healthcare professional's coagulometer which is checked in line with an external quality assurance scheme. Ensure accurate patient records are kept and shared appropriately.

[Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care coagulometers (the CoaguChek XS system) (2014, updated 2017) NICE diagnostics guidance 14, recommendations 1.3 and 1.4]

Equality and diversity considerations

For adults with atrial fibrillation who may have difficulty with or who are unable to self‑monitor, such as people with disabilities, the possibility of their carers helping with self‑monitoring should be considered. Coagulometers currently come at a cost to the adult with atrial fibrillation, so reasonable adjustments should be made for the socioeconomic status of the adult.