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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.
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
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 I’m sad, I’ve lost a patient • 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
INCOMPLETE INDUCTION • Patients are sent home before the Induction protcol has been completed What dose now? Very Frustrating
ANSWER COMMUNICATION COMMUNICATION COMMUNICATION.