IN-PATIENT WARFARIN CONTROL
at
PINDERFIELDS GENERAL HOSPITAL,
WAKEFIELDBY
PHILIP BOOTH
SENIOR B.M.S.
ANTICOAGULANT CO-ORDINATOR
WE DEAL WITH TWO TYPES OF PATIENT
Patients who are admitted already on warfarin.
Patients who are Inducted onto warfarin whilst in hospital.
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
THESE FORMS ACT AS :
Patient ReferralINR Request FormINR Result SheetDosage Form
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.
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.
STAFFING
• WEEK-DAYS – 1 BMS 2, Full Time
2 BMS 1, 2 monthly cycle.
• WEEK-ENDS - 1 BMS, May not be from Haem.
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.
ADVANTAGES OF LAB DOSING
CONSISTANCY OF DOSING
• Doctors have different ideas, from previous Hospital Dosing systems
NEW PATIENTS
• We can obtain accurate personal and medical details for Dawn AC
COMPUTER RECORDS
Ensures all patients INR and Dosage records are kept upto date
ADMITTED PATIENTS
• We know when our Clinic Out-Patients are admitted into PGH. For an operation
DISADVANTAGES OF LAB DOSING
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.
“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?
WARFARIN CHARTS
• Get Lost!!• Ward name not
written on• Ward name not
changed when patient moves to a new ward
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
INCOMPLETE INDUCTION
Patients are sent home before the Induction protcol has been completed
What dose now?Very Frustrating
THE FUTURE
ANSWER
•COMMUNICATION
•COMMUNICATION
•COMMUNICATION.
THE END