Warfarin Dosing Tool
From the Warfarin dose screen clinicians can easily monitor and calculate INR and Warfarin dosing respectively. It can only be accessed when a New Diagnosis Indication has been entered through the Warfarin screen, see Warfarin/INR Diagnosis . The dosing tool looks at the previous INR and dose history and calculates the new weekly dose.
The screen is split into four tabs. The main INR and Dose tab is the one from where the calculation is performed. The topics below explain the different sections and tabs within the Warfarin Dosing Tool screen.
Viewing Current INR Dose
This area of the Warfarin Dose screen gives details of the current diagnosis indication, previous INR value and previous weekly dosing regime, along with relevant dates. The information in this section is for reference purposes only and cannot be changed. Any data that is recorded into the patient's record automatically populates on this screen.
- Start Date - This section shows the patient's Diagnosis Indication date and their INR target.
- INR Date - The patient's last INR result displays alongside the date.
- Dose Date - This shows the patient's current daily dose over a week.
- Recall Date - This is the date when the patient should next be seen. The recall interval is based on the patient's INR doses. The more INR results recorded when starting to use Anticoagulation Manager the more accurate the recall date will be.
Adding a New INR and Dose
The information in this section is for the new INR details and dose. To record a New INR value and allow Warfarin Management to recommend a dosing regime do the following:
- Type directly into the INR box the new INR value, or if you receive lab results directly into Vision, the results are automatically populated and show the latest entry in the Current INR section.
- The Advised Warfarin Adjustment is shown. If correct, click on the Use button to allow the regime to be calculated. Select either Round Up or Round Down if displayed. (If the dose cannot be achieved with the tablet strengths available then the option to round the weekly dose Up or Down will become available and must be selected before clicking on Use).
- To prescribe the same Warfarin dose for each of the days make sure a tick is placed in the Same Daily Dose box. Clearing this will allow Vision+ to calculate a Warfarin dose that may be different from day to day in order to allow the exact weekly Warfarin dose to be prescribed. This check box will affect the Round Up and/or Round Down warfarin dose values.
- The weekly dosing regime will then be shown, and can be printed out and given/posted to the patient by clicking on Print A4 Report.
- The recommended Recall date is shown or can be recorded by choosing a date from the calendar. The recall intervals are taken from the patient's INR history as below:
- One latest INR within range the recall interval is set to One week
- Two latest INR's within range the recall interval is set to Two weeks
- Three latest INR's within range the recall interval is set to Four weeks
- Four latest INR's within range the recall interval is set to Six weeks
- Five latest INR's within range the recall interval is set to Eight weeks
- Six latest INR results within range equals a Ten week recall
- Seven INR results within range equals a Twelve week recall
- Optionally, the INR and Warfarin Dose data can be viewed on the History and Trends Tab.
- Select OK to save the changes to the Warfarin Dosing Tool screen. Important - The patient's weekly dosing requirements are recorded in their journal.
Algorithm Initiation Period
You are warned if the Warfarin Dose tool is not suitable for use in the first two weeks of initiation of Warfarin and advised that the patient's recall is limited to the Maintenance period of one week. You are allowed to proceed but all recall calculations are made according to this Maintenance period.
New Weekly Dose
When calculating a patient's weekly dose, it is sometimes necessary to stop the warfarin dose for a day, then advise the patient to start a new weekly dose in a couple of day's time. The Warfarin Dosing tool makes the next weekly dose information visible in the dosing tool.
You see the following message on the Warfarin Dose screen, advising that the patient must miss 1 day and displays their new weekly dose.
The patient's record is also updated with a clinical term for Warfarin Weekly Dose with a comment of zero (0) to indicate that the patient must not take Warfarin along with the new recommended weekly dose.
INR Manual Dose Warning Message
The following warning displays if a patient's INR result peaks above 8 within the Warfarin Dose tool and a manual dose is not entered.
High INR Adjustment
If a patient has a high INR, then the INR returns to below 5 and the patient has a therapeutic range lower than 3.5 the following warning message is shown advising that the tool cannot calculate a dose and a manual dose should be entered: