Colm,

Some months ago there was an alert on RAT about new guidelines regarding a lowering of target INR for a group of patients.
I cannot remember the exact details.
There was print out and I think it talked about doing an audit to identify patient's that may have been affected by this change.
I would be grateful if you were able to remind me what it was and how to find the info on RAT,or email me a copy of it.

Gareth.

Dear Gareth

Here is the information...
Regards
Colm Rafferty

'Recurrent PE or DVT' is now divided into 2 groups.

Group 1: 'Recurrent DVT or PE on warfarin' INR RANGE: 3.0-4.0
These are patients who developed a subsequent DVT or PE while on warfarin.

Group 2: 'Recurrent DVT or PE not on warfarin' INR RANGE: 2.0-3.0
These are patients who developed a subsequent DVT or PE when no longer on warfarin.

The most common group will be group 2.


ACTION NEEDED...
1. Use the audit tool (spectacles icon)
2. Run the search: 'List all patients'

This will give you a list of patients who have 'Recurrent DVT or PE'
as their indication.

You will then need to search their clinical notes and find out
whether they belong to Group 1 or 2. Most commonly it will be group 2.
It would be uncommon to get a further clot while on warfarin.


When you access their record in RAT, Click on the 'Indication' tab
You will see their indication is 'Recurrent DVT/PE'
Then click on the small 'red rat' icon.
A message will appear to state they will be reassigned to Group 1
i.e. 'Recurrent DVT or PE on warfarin' INR RANGE: 3.0-4.0

N.B It is important that if they belong to group 2 that you change the indication
by selecting the 'Recurrent DVT or PE not on warfarin' from the drop down list.
You will see the INR range change to 2.0-3.0