Is it at all possible to amend the programme to allow the entry of the actual date the inr is taken on as opposed to 'today's INR'? I feel this is a little misleading when inr is not taken in house and we rely on the result coming from the lab. There is usually a one to two day difference.

Clinically this is probaly nit piking, but it could make a difference to our PCG audit. Currently I amend the details but this is long winded.

Many thanks

Dear Michelle,
You need to be careful. The date you enter the INr result is the day you will recommend changes. Some practices do not get the INR result until the next day. But you are instructing patients on warfarin changes on the day you deal with it not when the sample is analysed.
RAT deliberately only allows you to enter 'todays INR' because that is the day you will be giving instructions to the patient.
So you should interpret the date as the date the INR was dealt with, not the day it was taken and analysed.
Regards
Colm Rafferty

I have read and partially understood your reply - that the INR result , though taken on a previous date, should nevertheless be entered into RAT on the day the new instructions are given to the patient.
Our practice is small, so we may not have a set day for a Warfarin Clinic. If the blood samples are done on Friday, then the result will not be entered into RAT until Monday - three days later. If the blood test is taken on the other weekdays, then the results are entered the next day.
Our patients are nearly always started on Warfarin while in hospital, but they are often discharged early when the INR is not fully stabilized . The laboratory results - containing the historical INRs while an inpatient- are entered in RAT exactly as on the laboratory sheet. When the patients are home, the INR results entered in RAT will then be out of phase, because they will be 1 or 3 days late, depending when we receive them. I am worried that the inconsistent entries will cause a less dependable RAT recommendation.

Dear Hedley,
Historical INRs in hospital will have associated warfarin doses, so you will probably assume that the hospital doctor acted on that result on the same day.
Your difficulty medicolegally is not when the sample was taken but when you acted on it, so when a patient gets home there will be an apparent jump of 2-3 days with missing data.

I am assuming your laboratory has a protocol to phone a result to you if it is over a certain level.

You should consider putting pressure on the local lab to get your results on the day they were taken.
In our practice, the samples go off to the lab at 10:30am an are either phoned later or sent electronically via our lablink system.

You shoula also consider near patient testing. The sticks are now available on prescription so the only ongoing cost is the maintenance of the testing machine which costs about 300-500 GBP.

Regards
Colm Rafferty