Can anyone help me please.
We did an inr on a home patient, the result was entered into RAT at the surgery and the dosing for the week was printed off.
Somebody queried something on the same patient the next day and when checking RAT the dosing for each day on the screen was completely different to the version that was printed the day before. The total for the week did stay the same.
This has obviosuly caused major confusion for the patient and for us!

Help!!!

Dear Joanne,
Can you check what the total weekly dose is/was?
Was it checked on the same PC?
I assume there is no problems with the date settings if it was a 2nd PC?
Can you let me know the differences in the two weekly regimens.
Can you also let me know the previous weekly warfarin dose, INR, the latest warfarin dose and INR and the reference range and indication so I can test it
thanks.

In older versions of RAT there were anomalies, where RAT had to readjust weekly dosing if there was manual adjustment of dosing made.

Regards
Colm Rafferty

Dear Colm,

The weeks total dose was the same = 18mg INR = 4.2 11.11.09

The original printout showed:-
Mon 3mg
Tue 3mg
Wed 2mg
Thu 2mg
Fri 2mg
Sat 3mg
Sun 3mg

Any subsequent printouts for this patient are showing:-
Mon 2mg
Tue 3mg
Wed 2mg
Thu 3mg
Fri 3mg
Sat 2mg
Sun 3mg

This was checked on the same and other computers.

The previous INR = 1.6, weekly dose = 22 04.11.09

INR range is 2.0 - 3.0
Indication is Recurrent DVT /PE (long term)

I look forward to hearing from you.
Many thanks, Joanne

Dear Joanne,
Thanks for the feedback.
The original printout
Mon 3mg,Tue 3mg, Wed 2mg, Thu 2mg, Fri 2mg, Sat 3mg, Sun 3mg
is not the standard RAT dosing for a week.
Notice that the 3mg dosing are bunched together.
Normally the 3mg and 2mg are spread across the week as in the second one you have sent me:
Mon 2mg, Tue 3mg, Wed 2mg, Thu 3mg, Fri 3mg, Sat 2mg, Sun 3mg

RAT does this so that the INR is smoothed out across the week.

So, I think what has happened is that the user has manually overrided the standard dosing and replaced it with the first pattern.

RAT will usually store the modified pattern, but RAT will attempt to return to the standard pattern to that the distribution of the dosing is even across the week so that the dosing for subsequent weeks keeps to the same even pattern.
This can happen if the user views the 'Edit previous warfarin/INR dose' screen and clicks the 'OK' button, or does not save after printing.

I hope this makes sense,
Colm Rafferty