Transcript inpatient

IN-PATIENT WARFARIN
CONTROL
at
PINDERFIELDS GENERAL
HOSPITAL,
WAKEFIELD
BY
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 Referral
INR Request Form
INR Result Sheet
Dosage 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.
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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!
I’m sad, I’ve
lost a patient
Do not worry!
Dawn AC is at hand
Simply pull a “No Appointment
List” once a week
INCOMPLETE INDUCTION
Patients are sent
home before the
Induction protcol
has been
completed
Very Frustrating
What dose now?
THE FUTURE
ANSWER
•COMMUNICATION
•COMMUNICATION
•COMMUNICATION.
THE END