Detect, Protect And Perfect - Stroke Association

IntroductionIntroductionto pan LondonprogrammeDataDETECTDetection dataand explanantionDETECTPROTECTAtrial Fibrillation(AF) toolkitDetect, Protectand PerfectLorem ipsum dolorsit ametAnticoagulationResourcesPROTECTPERFECT PERFECT ConclusionReferencesLorem ipsum dolorsit ametLorem ipsumdolormythsit ametbusters Lorem ipsum dolorsit ametContactContactususLorem ipsum dolorsit ametThis toolkit providesmethodologies,resources and supportfor commissioners andclinicians workingto reduce AFrelated strokesWorking together acrossLondon to preventAF related strokesGetStarted

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan eword and IntroductionThe AF Improvement CycleData (including all London CCGs AF infographics)Detect (including devices review)ProtectPerfectAnticoagulation myth bustersReferences and acknowledgementsContact usAnticoagulationmyth bustersResourcesContact us

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesContact usFOREWORDEvery year in London about 2,000 (SSNAP2015-2016) people get admitted to hospitalwith a stroke due to atrial fibrillation (AF).More than half of these people, despite beingknown to have AF before their stroke, arenot receiving anticoagulation of any sort.Although we don’t have the data it is likelythat many of the people who are listed ashaving been prescribed warfarin are not intherapeutic range. A conservative estimateis that 625 people a year in London couldhave their stroke prevented with correctmanagement.Stroke caused by AF tends to be severe andis associated with significant mortality andmorbidity. The average costs of both healthand social care for stroke have recently beencalculated to be an average of 44,434 overthe first 5 years (data not yet public). The toppriority for commissioners is to fund servicesthat are most likely to improve the health andwellbeing of their population.However, this has to be done within theavailable budget. Detecting AF throughopportunistic pulse checks would cost virtuallynothing. Anticoagulating these patientsrequires effective delivery systems andenhanced communication between all thoseresponsible for patient care. Many patientscan be managed perfectly well with warfarin,which is a cheap and effective anticoagulantwhen managed correctly. Increasingly, theadvantages of the newer oral anticoagulantsare being recognised by both clinicians andpatients. Although these drugs are relativelyexpensive, the cost is considerably less thanthe costs for one person who experiences astroke.Failure to prescribe an important treatmentneeds to be seen as an error that is equally asserious as prescribing the wrong treatment.This toolkit provides useful information andsupport for those commissioning services forand treating people with AF in London.We hope that it will enable commissioners andclinicians in London to lead the way in showingthat correct management of AF is not difficultto deliver, that in doing so we prevent a hugeamount of suffering for individuals and theirfamilies and avoid an unnecessary burden onour health service.Tony Rudd CBENational Clinical Directorfor Stroke, NHS EnglandMatt KearneyNational Clinical Directorfor CardiovascularDisease Prevention,NHS England

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesContact usThe pan-LondonAF ProgrammeThere are 15 Academic Health Science Networks (AHSNs)established by NHS England with the aim to spreadinnovation at pace and scale, improving health and generatingeconomic growth.In addition across England there are 12 Clinical Networkswhich provide the clinical expertise and leadership to drivecommissioning decision making, reduce variation and directservice improvement. The London Clinical Networks arefocussed on specific areas of clinical care, including theLondon Stroke Clinical Network.The London AHSNs The Health Innovation Network, ImperialCollege Health Partners and UCLPartners, have collaboratedwith the London Stroke Clinical Network to deliver a panLondon approach, working with clinical commissioninggroups (CCGs) and providers to reduce AF related strokes.

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesContact usINTRODUCTIONand purposeWithin clinical and commissioning settings preventing AFrelated strokes is a priority. There is evidence of outstandingwork delivered by the NHS, charities, and industry to improveAF care and outcomes for patients within London andnationally.To navigate the available resources they are organised aroundthe different parts of the AF pathway. There are three domains,Detect, Protect and Perfect. Within each domain there are three‘opportunities for improvement’ in order to help determine whereto focus improvement efforts.To ensure all commissioners and providers are aware of existinginitiatives and accompanying resources this toolkit bringstogether a series of practical tools and case studies to informthose working on an AF project.Whichever domain or opportunities for improvement youconcentrate on, our AF Improvement Cycle is designed to informyou of the core elements that make up the foundations of an AFimprovement project.It is anticipated that this repository will continue to growas further examples of great practice or new resources arepublished.More information on the pan-London AF projectcan be found here in our position statementThe pan-London AF project team have developed AFquality standards and system level impact measuresfor prevention of AF related strokesThis toolkit is aimed at health care professionals and commissioners. People with Atrial Fibrillation should consult with their healthcare professional as they would normally do, when discussing the management of their AF. We would like to emphasisethat clinical decision making remains the sole responsibility of individual clinicians, and that any information provided is for information and educational purposes only and is not intended to constitute professional advice, diagnosis or treatment, or asa substitute for professional judgement. We cannot endorse resources developed by other organisations and therefore individuals and organisations take full responsibility for any use that they undertake of these resources.

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesContact usWithin the three AF domains Detect, Protect and Perfect we have highlighted nine opportunities for improvement. The AF ImprovementCycle on the following page provides a framework in which each opportunity for improvement should be considered.FIND MORETREAT MOREPROTECTDETECTAwarenesscampaignsPulse checksDetectiondevicesIncrease anticoagulationInititate anticoagulationin communitysettingsHeart rateand RhythmcontrolTREAT BETTERPERFECTExcellence inanticoagulantcareSelfmanagementand SelfmonitoringAdherenceto oralanticoagulant

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesThe AF Improvement CycleUnderstand local dataDETECT PROTECT PERFECTPrepare Plan how to secureresources Assess Appoint a teamincluding clinical leadand project managerAnalyse localpopulation dataand benchmarkagainst peers Secure senior/executive supportLearn from successelsewhere Reviewperformance ofexisting servicesagainst agreedlocal or nationalstandardsAgree projectgovernance,baseline metrics andreporting structure Engagestakeholders andassess readiness forchangeImplementand evaluatePlan Build capacitythrough engagementand training Project manage theimprovement andany risks Agree an achievabletarget and howto track progressagainst baselineperformance Measure progressagainst improvementmetrics as frequentlyas possible Create enablersfor change e.g.incentives, practicalresources, guidelinesCollect and setup feedback fromproviders and users Capture and sharelearning Agree the‘opportunity forimprovement’, targetsetting and patientcohortThis cycle has been developed through understanding the critical success factors within AFimprovement work undertaken in London. It can be applied to any of the three AF domains.Contact us

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan LondonprogrammeDataDETECTPROTECTUnderstand yourlocal populationThe pan-London AF Programme have produced a seriesof infographics for each CCG using Quality and OutcomesFramework data (QOF), Sentinel Stroke National AuditProgramme (SSNAP) and the National CardiovascularIntelligence Network (NCVIN) data.For each CCG the infographics outline: The proportion of patients on a GP register with AF comparedto the expected prevalence The percentage of people with known AF at risk of stroke whoare treated with anticoagulants The number of GP surgeries who treated at least 80% of theirAF patients at risk of stroke with anticoagulants The number of strokes in people with known AF The percentage of those people who had a stroke with knownAF, who were not receiving anticoagulation therapyClick here to download yourlocal CCG infographicPERFECTAnticoagulationmyth bustersResourcesContact us

AF toolkit Detect, Protect and PerfectWorking together across London to prevent AF related strokesIntroductionto pan tionmyth bustersResourcesContact usData - Understand your local populationUnderstanding your local data is vital to identify areas for improvement and is the first step in any AF project.Detect dataProtect dataPerfect dataUnderstand the actual local prevalence of AFcompared to the expected prevalenceIdentify people with AF not receiving optimalanticoagulationGather local knowledge on anticoagulant services.Ensure you capture data on the following areas:QOF data shows actual AF prevalence. For CCG level dataselect QOF 2015-16 prevalence, achievement as exceptions atCCG Level v2QOF data will show the proportion of patients with AF and atrisk of stroke who are anticoagulated Criteria for referral (inclusion and exclusion)Click here › Waiting times from referral to anticoagulant treatmentFIND MORETREAT MORETREAT BETTERClick here › Pathways (clinical and administrative) Time in Therapeutic Range (TTR)The National Cardiovascular Intelligence Network (NCVIN) hasproduced models of expected prevalence of AF by CCGPrimary Care Intelligence Packs provide data on CVDprevention, detection and managementClick here ›Click here ›Public Health England Health profiles give a snapshot of AFdata for each local authority in England.Sentinel Stroke National Audit Programme (SSNAP) willhighlight the number of patients with known AF prior to theirstroke who were not anticoagulatedThe London Stroke Clinical Network has produced a checklistfor excellence in anticoagulation which can be used tobenchmark your service.Click here ›See PDF ›NHS RightCare CVD focus packs help CCGs identify ‘what tochange’ by using data to identify improvement opportunitiesAF quality metrics have been developed to support cliniciansand commissioners to review care of people on local AFregistersClick here ›Public health AF prevalence modellingClick here ›Click here › Numbers of patients self-monitoring and self managingSee PDF ›The NHS Specialist Pharmacy service outlines how toaccess and use the various data sources on medicinesoptimisation in AF, to assess the quality of care.Cardiovascular disease prevention optimal valuepathway This evidence based pathway has beenproduced by NHS RightCare