1. PROTIME MACHINE Lisa Ritchey, RN Sherrie Thomas, RN Tracey McCaulley, RN

2. OBJECTIVES Define and describe trend List and describe trend hardware and software Identify, describe and review trend information system Describe advantages/disadvantages of using trend Examine legal and ethical issues related to use of trend Describe technology-related competencies needed by the professional nurse working with trend Describe functions of the informatic nurse working with trend

3. TREND IN ANTICOAGULANT THERAPY MONITORING Traditional Patient goes to lab Lab runs test; gets results Lab calls results to doctor Doctor adjusts coumadin dose Nurse informs patient of dosage change Traditional Patient goes to lab Lab runs test; gets results Lab calls results to doctor Doctor adjusts coumadin dose Nurse informs patient of dosage change New Patient runs test Patient gets results Patient adjusts coumadin accordingly New Patient runs test Patient gets results Patient adjusts coumadin accordingly

4. Implementation of protime machine in home settings WHY? In the new paradigm of patient-professional partnership patient self-management results in improved clinical outcomes with same quality of anticoagulation management. GOAL: Implement best practice in managing coumadin dosages in patients on long-term anticoagulant therapy by performing PT/INR testing in the home..(Beyth, 2005)

5. Hardware Protime Machine (ITC, 2006) Cuvette Tenderlett Plus

6. Software Coagutrax Built in alerts Built in patient dosing tool Source of documentation Interfaces with the EMR Automated charge entry (Medmatics, 2005-2009) Coagutrax

7. ADVANTAGES cost effective Speed of results convenient Less invasive

8. DISADVANTAGES dexterity ability Required controls Equipment cost

9. CostCurrent ProcessProposed Process Mileage$10.80$0 Travel time$30.72$0 Increase staffing Costs $49.00$0 Cost of supplies$0$5.00 (ITC, 2006)

10. Ethics Related To Home Monitoring Of PT/INR Responsibility shifts to the patient Patient’s are not skilled clinicians Impact on patient-professional relationship (Martin, 1999)

11. Legal Issues Nurses competency Corporate liability Personal liability Patient confidentiality (Sullivan, 2005)

12. Technology-related competencies Nurses must be proficient in: Use of hardware Use of software Conversion of data into information Application of information into knowledge Incorporation of knowledge into practice (Sullivan, 2005)

13. Functions of the informatics nurse Critique the trend Evaluate hardware and software for usability Collect evidence to support best practice (Sullivan, 2005)

14. Summary An example of new technology No delay in treatment Support for best practice

15. References Beyth, R. J. (2005). Patient Self- Management of Anticoagulation: An Idea Whose Time Has Come. ITC (2006). ProTime Machine Microcoagulation System. Martin, P.A. (1999). Bioethics and the whole: Pluralism, Consensus of the Transmutation of Bioethical Methods into Gold, Journal of Law,Medicine, and Etjics, 27 (4), 316-327.

16. References Cont. McGonigle, D. and Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Boston: Jones and Bartlet Publishers. Medmatics, LLC (2005-2009). Developers of Coagulax, Anticoagulation Management Software.

17. References Cont. Mendez-Jandula, B. M., Souto Juan Carlos, M.M., Oliver, A.M., Montserrat, M., Quimntana, M. R., Gich, I. M., et al. (2005). Comparing Self-Management of Oral Anticoagulant Therapy with Clinic Management. A Randomized Trial. Annals of Internal Medicine, pp. 142: 1-10.

18. References Cont. ProTime PT-INR Testing Monitor-Process Efficiency. (2008, January 31). Retrieved December 4, 2009, from Pro Time Test provided by QAS:http://www.protimetest.com /homehealth efficiency.asp. Sullivan, E.J. (2005). Effective Leadership and Management in Nursing. Upper Saddle River, NJ: Pearson Education, Inc.