We are signing up to a new LES based on new guidelines. Are there any changes being made to RAT to help with the new requirements?

On a broader question, are there any plans to integrate with EMIS so INRs are posted to the pt record automatically?

Dear John,
Can you give me a reference to the new guidelines of any particular reference that you believe needs addressing?

Much of the latest guidance is about training, making sure anyone doing INR monitoring is fully up to date. Birmingham University runs courses on INR management.

I do not plan to integrate RAT to any of the clinical systems.
Technically not worth the hassle.

Regards
Colm

Our report to the PCT for the first quarter 1st April- 30th June of 09/10 is now due to be sent. In past yrs we have just sent the PCT Report print out from RAT but now we have to complete Appendix 2 which inc questions such as:-
1. Average number of DNAs
2. Standard: 50% last INR within +/- 0.5 units
3. Standard: 80% last INR within +/- 0.75 units
4. Percentage incidence of pts suffering a major bleed in first month of therapy and percentage suffering major bleed with INR above therapeutic range
5. Percentage of INRs above 8.0
6. % of INRs 1.0 below target
7. % of pts suffering adverse outcomes categorised by type

There are a total of 14 indicators on the report. The others are covered OK by the standard PCT report.

Dear John,
Thanks for your feedback.
I'll deal with each one separately.

1. Average number of DNAs
RAT does not use an appointment system. It works via the defaulters list: the 'red magnet' icon.
Each time you click the red magnet you can see how many patients are due/overdue their INR check. You could take snapshots of this over a period of time to count the number of defaulters. Patients never move down the defaulters list until they have their INR check so it is a more timely view, rather than having to go looking for DNAs via searches.
In our practice we use the main clinical system for scheduling appointment times


2. Standard: 50% last INR within +/- 0.5 units
3. Standard: 80% last INR within +/- 0.75 units
If you look at the last search in the list 'Point revalence percentages' this will give you these results. This is also part of the PCT report.
4. Percentage incidence of pts suffering a major bleed in first month of therapy and percentage suffering major bleed with INR above therapeutic range
See the answer to number 8
5. Percentage of INRs above 8.0
You will see in the list of searches, there is one called INRs >4.5 (named)
You can add a date range to this search. This will give you actual patients with recorded INRs.
Be careful that some lab sytems and near patient testing machines do not record above an INR of 7.

6. % of INRs 1.0 below target
You will see a search for patients < 1.5 (Named). Again if you add a date range.
7. % of pts suffering adverse outcomes categorised by type
RAT is an INR monitoring system. Significant events will happen outside the INR clinic. The patient may be admitted to hospital of attend a GP in surgery time.
Each clinician must have a way of feeding back any of these events. This is required for your DES. You must report any significant event to your PCT.
This category will have very low numbers. So a percentage is not really a proper useful report. they should be dealt with via your significant event meetings.

I will look at amalgamating these into the PCT report.
The most important and poorly reported is the significant events. An example is where a patient has a bleed, admitted directly ot hospital and the discharge letter arrives a number of weeks later to a clinician not directly involved in warfarin management and the event does not get reported.

Regards
Colm Rafferty