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. 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.

THE END