Kalsi Pharmacy

Mobile Computing Solution Transforms the Management of Anticoagulation Treatments



Kalsi Pharmacy has been providing community-based anticoagulation services with approximately 1,000 patients for a number of years, in the Barking and Dagenham areas of London.

The Challenge

In 2014, the local anticoagulation service was put out to tender by Barking and Dagenham NHS CCG under the Any Qualified Provider (AQP) guidelines. AQP guidelines stated that 3 criteria had to be met as part of the requirements for the anticoagulation service.

Point of-care testing (POCT) was to be supplied.

The service provider was to make appropriate arrangements to ensure that the service was available on a domiciliary basis to house-bound patients requiring anticoagulation monitoring and on-going management.

The solution was to include a Computer Decision Support Software (CDSS), for dosing advice and frequency of testing.

INRstar N3 CDSS was already in use by primary care AC providers in the area and more recently implemented by secondary care making it the most widely used CDSS software by primary care anticoagulation (AC) treatments providers in the area. A key advantage of using the INRstar N3 CDSS is that AC patients are managed on the same CDSS throughout the area making a patient’s AC clinical history and dosing information more easily accessible to other local AC providers. This allows patient choice, provides greater patient safety and continuity of care.

Kalsi Pharmacy decided that it would be advantageous to replace their existing dosing software with INRstar N3. However, as a large percentage of their patients are managed on a domiciliary basis, Kalsi Pharmacy identified the need to equip their pharmacists with a mobile solution that would allow the INRstar N3 software to be accessible outside of the main pharmacy.

The Approach

Dakota Healthcare provided Kalsi Pharmacy with its Dakota Secure Remote Access (DRSA) solution that eliminated paperwork, supporting clinicians’ normal way of working and providing realtime patient information at their remote clinics. All clinicians were provided with DRSA on their existing laptops, which enabled them to direct real-time access to SCSL’s INRstar AC software via N3, significantly improving the service they provided to their Anti-
Coagulation (AC) patients and management of their domiciliary clinics. With DRSA and live access to INRstar via their existing N3 connection at the pharmacy, Kalsi pharmacists are able to complete all clinical documentation, test, calculate patients Warfarin dosages at the point-of-care whether it be at the remote clinics or at the patient’s home. The fact that the pharmacists have access to all up to date and relevant patient information and can immediately input the latest patient clinic episode into the INRstar application at the point-of-care removes the risk of incomplete notes, therefore providing it patients a much safer service.

Commenting on the solution, Surinder Singh Kalsi, Lead Clinician said:

"As an organisation, we have seen massive reduction in handling times and associated costs since the introduction of this solution. It has allowed us to reduce clinical risk significantly and compliance to warfarin medication has vastly improved. Service costs have been reduced too, eradicating the previous double handling of patients, and the faster process ultimately means that staff are more productive and patients given a greater quality of care.

The solution is extremely flexible to our needs. We are an expanding Primary Care provider with currently four locations, with strategic plans to grow further in the next two years. A multi-organisation requires a IT solution that is transferable between locations. The ease in which we are able to move the hardware between site, linked with INRstar’s central web hosted system access make this solution future proof for our need and the needs of our patients."

The Result

Benefits to Kalsi Pharmacy

Real-time remote access to clinic and patient data. By providing the anticoagulation service provider access to real-time patient data at the point of care, a safer and more effective process can be delivered to its patients.

No administration work required at the pharmacy prior to running the remote clinic. Since Kalsi Pharmacy no longer needs to spend time at the pharmacy both prior to and after the clinic, the Pharmacy can see more patients without having to extend the clinic times.

Benefits to patients

Anticoagulation services patients now receive an improved, more flexible, efficient and streamlined service from Kalsi Pharmacy. This results in a much improved patient experience, whilst at the same time improving care and outcomes.

Compliancy to AQP Guidelines

Kalsi Pharmacy is now fully compliant under the AQP guidelines, which should stand them in good stead when contracts are due to be renewed in March 2017.