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This icon allows you to search for a patient |
It is useful if you cannot find a patient on the
review list as detailed in the next image. I recommend you use the 'magnet'
icon as below to find a patient. |
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This icon lists the patients due for review. |
It is the most commonly used icon to find a
patient. Defaulters will always appear at the top of the list. I recommend
using this method to find a patient as it is a continual prompt to look at
patients who are overdue an INR test. The list details their review date and
also the site where the INR is due. This is useful for community nurses who
need to visit the patient at home to take a sample. |
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Once you have found the patient, you can now enter
the INR. You will see the combobox. The INR values in this combobox range
from 1.0 to 5.0. If the INR is larger than 5, you can type in the value into
the box.
There is a 'weekly monitoring ' option. This is
for potentially unstable INRs. An example is where a patient is currently
undergoing chemotherapy.
Below this you will see the scribblepad. This
is like a post-it note. You will see two options for the scribblepad. 'Keep
visible' allows any message to stay present each time you open the patient
record. 'Archive with INR' removes the message and logs it in the
'continuation notes' (see bottom left of screen).
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When you click the 'recommendations' tab, RAT will
calculate the new warfarin dose and review date. There may also be comments
especially of the INR is high or low. In this case the patient was overdue,
so rather than giving at least a four week review date, RAT asks for the
patient to be reviewed earlier. there are over 300 different patterns that
RAT will search on and suggest comments. You can print out the
recommendations using the print icon to the top right of the screen.
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In this case, the INR is high. You can see the
list of comments output by RAT. You can also see the historical comments by
RAT in the 'continuation' notes.
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Sometimes the patient will state that the warfarin
dose they are taking is not the same as was previously suggested by RAT.
This could be for a variety of reasons. They may have been in hospital and
had a new dose regimen, they may have had a medical consult since the last
visit and the dose altered or they may have simply incorrectly recorded
their weekly dose. For wahtever reason, you may need to change the previous
weekly dose so that RAT can calculate the new dose. To modify the last
recommendations, Click on the 'Grid' icon highlighted.
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When you click on the 'Grid' icon, this window
will appear.
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Hightlight the first row and the boxes at the top
will automatically fill in. Make your adjustments which is usally to change
the weekly INR total. Then click on 'Modify' and then OK.
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You can also change other parameters within RAT.
Here you can change the indication for warfarin treatment. This would be
rarely used. One example may be if a patient develops atrial fibrillation
while on warfarin for a DVT/PE. You would change their indication. Their
treatment length would automatically change from short to long term.
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You may need to change the reference range for an
indication also, though again, this would be unusual.
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Again you may need to change the treatment length.
An example may be for a DVT, where the patient's specialist may ask for
warfarin to be continued for a longer period if they felt the DVT was quite
extensive.
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Here you can change the patient's personal details
by clicking on the 'black figure' icon highlighted.
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This window will appear.
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The graph tab can give you a visualization of how
stable or erratic the INR / warfarin levels have been over the past 12-24
months.
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You can adjust the time length of the graph.
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Occasionally you amy want to adjust the
recommendations. Beside the print icon you will see an icon to show this
screen. You can adjust the daily dosing here. It is advised that you do not
make the dosing unusual. RAT profiles the warfarin across the week and
increments or decrements the dose smoothly to allow for consistent INR
readings.
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