The New Face of the ‘Yellow Book’

In January 2006 the National Patient Safety Agency (NPSA) published a risk assessment of antocoagulation care pathways(1). In developing this document the NPSA looked at published literature, data from professional indemnity insurers, the National Health Service Litigation Authority (NHSLA) and error reporting schemes from across the world including the NPSAs own National Reporting and Learning System.

In addition they also ran a series of meetings for both patients and healthcare practitioners to try and establish exactly where the key risks were within anticoagulant care pathways.

oral-anti-ther The result was that the risk assessment identified a number of areas relating to anticoagulants where work needed to be done to make the whole process safer for patients. The NPSA then worked with a range of stakeholders including patient groups and the British Society for Haematology to address those issues and published a Patient Safety Alert “Actions that can make anticoagulant therapy safer”²in March 2007. Probably the most visible of the actions for patients, was the redesigning of the “yellow book”. Comments from patients included that it needed to contain more information, and be available in a range of languages other than English. Different anticoagulant clinics had also started using different formats to record patient’s INR results. Some still wrote or printed the result into the old style yellow book, whilst others issued printed sheets of paper containing the patient’s results and details.

These records therefore needed to be kept in one place that allowed for different formats of recorded results. This increased amount of information, and the requirement to store records, resulted in the new patient information package becoming A5 in size and comprising the following three separate elements.

A credit card-sized ‘alert card’ with basic patient information, which is designed to be carried by the patient at all times. It informs healthcare professionals that the patient is taking oral anticoagulants and has space for the contact telephone number of the anticoagulant clinic. This may be useful in an emergency, or when a patient is consulting a range of healthcare professionals such as pharmacists, dentists nurses etc. who may not have access to their full medical notes. It can be extremely important that these professionals are aware that a person is taking anticoagulants and where they can contact for further information if they are to help keep the patient safe.
Updated patient information providing a concise guide to taking anticoagulants. This is in larger format than before and is intended to remain with the patient and be readily available for reference. This booklet is not intended to be carried at all times and need only be issued once to the patient. It is important to understand that, unlike before, this is now separate from the monitoring booklet, and if patient’s have not received this information they should ask for it at their clinic. Translations of the patient information are available in a range of different languages on the NPSA website for downloading and printing when required. Some clinics may not use the yellow book itself, in which case they should provide a local equivalent version of the information.
Space at the back of a folder to store records of INR test results, dosage information and the next clinic appointment. These may be handwritten records made by a healthcare professional or the patient, or computer- generated records sent to the patient by the anticoagulant clinic. The new booklet also has space for information concerning the local anticoagulant service and clinic contact details. Again, it should be noted that this is NOT the patient information book, but a record of results only.

Copies of the new ‘Yellow Book’ can be ordered by clinics from the following:

3M Security Printing and Systems Limited (3MSPSL)
Telephone enquiries – 0845 610 1112
Web-based ordering system – www.nhsforms.co.uk
Email address – nhsforms@spsl.uk.com

This article first appeared in the Journal INReview, published by Anticoagulation Europe. Issue no 29 – Winter 2008.

References

National Patient Safety Agency. Risk assessment of anticoagulant treatment. (2006). Available at www.npsa.nhs.uk/health/alerts
National Patient Safety Agency. Actions that can make anticoagulant therapy safer. Patient Safety Alert 18. Available at www.npsa.nhs.uk/health/alerts