1. Does your Trust have an Anticoagulant Service for:
a) In-patients and out-patients YES • NO •
b) In-patients only YES • NO•
c) Outpatient only YES • NO •
2. How many inpatient beds does your Trust have (at each site if more than 1 site)?
a) How many sites do you inpatient dose (if applicable)?
3. Who doses VKA for your inpatient population?
a) Doctors •
b) Advanced nurse practitioners •
c) Biomedical Scientists •
d) Clinical Nurse Specialists – if so are they nurse prescribers? •
e) Pharmacists – If so are they prescribers? •
f) Other – free text box
4. How many individuals who are not doctors perform this role in the groups specified above?
5. If you dose warfarin for out-patients, how many warfarin patients do you currently dose?
a. Which dosing software do you use – free text
6. Does your Trust run nurse led Anticoagulation clinics?
YES • NO •
7. If there are no nurse led clinics, who is responsible for management of patients taking VKA within your trust
8. Who completes your VTE Risk assessments?
a. Ward doctors •
b. Nurses •
c. Pharmacists •
d. ANP •
e. Other • – Please specify
9. What is your current VTE Risk assessment compliance rate?