Download - IN-PATIENT WARFARIN CONTROL
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IN-PATIENT WARFARIN CONTROL
at
PINDERFIELDS GENERAL HOSPITAL,
WAKEFIELDBY
PHILIP BOOTH
SENIOR B.M.S.
ANTICOAGULANT CO-ORDINATOR
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WE DEAL WITH TWO TYPES OF PATIENT
Patients who are admitted already on warfarin.
Patients who are Inducted onto warfarin whilst in hospital.
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WE USE TWO TYPES OF WARFARIN CHART
An Induction Chart, for patients starting Warfarin.
A Continuation Chart, for patients on Warfarin, when admitted to PGH
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THESE FORMS ACT AS :
Patient ReferralINR Request FormINR Result SheetDosage Form
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CHART DETAILS
Personal Details: Name, Address, Post Code, Date of Birth, Hosp No. Telephone contact, personal contact
Anticoagulant Details :A/C Reason, Duration, INR Range, Drug Info.
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WARFARIN CHART TRAVELS
WARD –Sample brought to Lab with Chart by Phlebotomist
LAB – Sample analysed, INR used to calculate Dose. INR, new Dose and Next INR-Check added to Chart.
WARD – Ward Chart returns to Ward on Porters 1-00pm Report –run.
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STAFFING
• WEEK-DAYS – 1 BMS 2, Full Time
2 BMS 1, 2 monthly cycle.
• WEEK-ENDS - 1 BMS, May not be from Haem.
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SAMPLE NUMBERS
• Monday,Tuesday Fridays :- 10 to 30 patients
• Wednesday,Thursdays :- 5 to 15 patients.
• Induction Patients are tested daily.• Patients with high INRs tested daily.• Patients in control tested once or twice a week.• Only Induction Patients and high INRs tested at
week-ends.
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ADVANTAGES OF LAB DOSING
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CONSISTANCY OF DOSING
• Doctors have different ideas, from previous Hospital Dosing systems
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NEW PATIENTS
• We can obtain accurate personal and medical details for Dawn AC
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COMPUTER RECORDS
Ensures all patients INR and Dosage records are kept upto date
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ADMITTED PATIENTS
• We know when our Clinic Out-Patients are admitted into PGH. For an operation
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DISADVANTAGES OF LAB DOSING
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PINK CHARTS
• Not on wards in the mornings, when Consultant rounds take place.
• Can’t be updated with Medical decisions. ie- Warfarin stopped, INR Range changed, New drug started.
• Someone on ward has to remember to update the Chart.
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“DOCTORS” !!
• Ward Doctors change the “Suggested Dose” for a reason the Lab doesn’t know anything about.
• For Operation• Medication change• Condition of Patient WHY DON’T THEY
TELL US?
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WARFARIN CHARTS
• Get Lost!!• Ward name not
written on• Ward name not
changed when patient moves to a new ward
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DISCHARGES
• Not being told by the wards, when a patient is discharged.
• This means they won’t be given an O/P appointment, and will be temporarily lost!
Do not worry!
Dawn AC is at hand
Simply pull a “No Appointment List” once a week
I’m sad, I’ve lost a patient
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INCOMPLETE INDUCTION
Patients are sent home before the Induction protcol has been completed
What dose now?Very Frustrating
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THE FUTURE
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ANSWER
•COMMUNICATION
•COMMUNICATION
•COMMUNICATION.
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THE END