Anticoagulation User Guide
Contents
1. e Locus of care This area of the screen shows the locus of care or you can add a new entry by selecting the appropriate Read code from Codeset G icon e Patient informed of result This displays when the patient was last informed of their result or you can add a new entry by choosing the appropriate Read code from the Codeset Lu icon e Home visit by Healthcare professional If the patient is attended by a healthcare professional it is shown in here provided the Read code of 9NFM Home visit planned by HCP has been used Alternatively you can add this entry by selecting the Read code e Booklet Warfarin Card Given The Information section provides an area where details of whether a Warfarin booklet and or card have been given to the patient along with the date they were provided The possible options are Yes No Declined or Unknown 19 D Note Booklet given and Warfarin card given are not recorded in the patient s journal e Prescriptions The most recent prescription for Warfarin is displayed along with the date prescribed A full history of Warfarin prescriptions issued can be viewed by using the drop down history arrow icon History Tab The History tab shows Diagnosis Indications along with their start and end date if applicable You also see the patient s INR history with dates and values and the patient s weekly Warfarin dose values shown in mg s per week INA amp Dose Treatment amp Advice Trends Desc2. Vision 3 Anticoagulation User Guide nina nie iin eine es nd 2 VISION amp Copyright INPS Ltd 2014 The Bread Factory 1A Broughton Street Battersea London SW8 3QJ T 44 0 207 501700 F 44 0 207 5017100 W www inps co uk Copyright Notice 2014 INPS All Rights Reserved No part of this document may be photocopied reproduced stored in a retrieval system or transmitted in any form or by any means whether electronic mechanical or otherwise without the prior written permission of INPS No warranty of accuracy is given concerning the contents of the information contained in this publication To the extent permitted by law no liability including liability to any person by reason of negligence will be accepted by INPS its subsidiaries or employees for any direct or indirect loss or damage caused by omissions from or inaccuracies in this document INPS reserves the right to change without notice the contents of this publication and the software to which it relates Product and company names herein may be the trademarks of their respective owners INPS Ltd The Bread Factory la Broughton Street London SW8 3QJ Website www inps co uk Contents ANTICOAGULATION PATHWAY 5 Overview 5 Getting Started 5 Accessing the Anticoagulation Pathway 6 An Overview of the Anticoagulation Pathway Screen 8 Toolbar and Data Entry Tools 9 Viewing or Adding Data to the Anticoagulation Template 10 Care Pathway 1
3. Trends Current INF and Dose Start Date Indication IHR target 01 09 201 3 Pulmonary embolus 2 50 IHR Date IHR 01 09 2013 5 00 Dose Date Daily Total Dose mg 01 09 2013 0 32 0 Recall Date No Data Recorded Current INR and Dose e Start Date This section shows the patients start date eg earliest diagnosis date check the indication and their INR target e INR Date The patient s last INR result is displayed alongside the date e Dose Date This shows the patient s current daily dose over a week e Recall Date This is the date when the patient should next be seen It is setup in the New INR and dose section Adding New INR and Dose The information in this section is for the new INR details and dose To record a New INR value and allow Warfarin Management to recommend a dosing regime do the following 1 Type directly into the INR box the new INR value or if you receive lab results directly into Vision the results are automatically populated and show the latest entry 2 The Advised Warfarin Adjustment is shown If correct click on the Use button to allow the regime to be calculated Select either Round Up or Round Down if displayed If the dose cannot be achieved with the tablet strengths available then the option to round the weekly dose Up or Down will become available and must be selected before clicking on Use Check if this works 3 To prescribe the same Warfarin dose for each of the days make sure
4. There is also an easy to use Clinical Pathway where you can quickly record relevant information In addition a suite of reports will capture data and provide a comprehensive reporting tool In all the Anticoagulation pathway comprises e Alerts for missing due data e Anticoagulation Templates which include Anticoagulation Therapy management screen Warfarin management and dosing tool Diagnosis Indication screen INR monitoring screen Management screen for New Oral Anticoagulant Drugs Other Assessment screen showing other factors that may affect the patient s anticoagulant treatment e Reporting facility which allows you to work on patient lists or create a mail merge This guide explains how to access the alert window and record data in the Pathway It also provides details of the reports that can be used to monitor your patients Getting Started The following topics provide useful information regarding setting up the Anticoagulation Pathway e Identify patients on Warfarin using the Anticoagulation Report You can quickly identify patients who are on Warfarin by running an Anticoagulation Report From the Vision front screen go to Reporting Practice Reports and select the Other icon Choose the Anticoagulation Pathways Report A suite of reports are listed The first report shows the number of patients on Warfarin For more information see Anticoagulation Pathway Reports page 26 e Alert Popup Window By defaul
5. a tick is placed in the Same Daily Dose box Clearing this will allow Vision to calculate a Warfarin dose that may be different from day to day in order to allow the exact weekly Warfarin dose to be prescribed This check box will affect the Round Up and or Round Down warfarin dose values 4 The weekly dosing regime will then be shown and can be printed out and given posted to the patient by clicking on Print A4 Report 5 The recommended Recall date is shown or can be recorded or by choosing a date from the calendar Where is this setup 6 Additional information can be recorded on the Treatment and Advice Tab if necessary 7 Optionally the INR and Warfarin Dose data can be viewed on the History and Trends Tab 18 8 Click OK to save the changes to the Warfarin Dosing Tool screen Hew INA and Dose INA Date INR 29 01 2014 Clear High INA Adjustment Round Up 24 5 Round Down 21 0 24 0 mgr week Same Daily Dose Dose Date Daily Total Dose mg 24 01 2014 Recall Date New INR and Dose Treatment and Advice Tab You can record the following on this screen INR amp Dose Treatment amp Advice f Histon Trends Locus of care No Data Recorded ILL Patient informed of result No Data Recorded iLL Home visit by Healthcare professional No Data Recorded LJ Information Booklet given date hi Watain card given date hi Prescriptions Warfarin Tong tablets 2970172014 hi Treatment and Advice
6. fibrillation sa gt Retinal vessel occlusion hi Peripheral arterial thrombosis z r Indication Start Date End Date Pulmonary embolus 03022014 OF Cancel Warfarin INR Diagnosis If a Diagnosis Read code does not exist in the patients clinical record the History column will be empty However a new Diagnosis Read code can be added at this point to allow a Diagnosis Indication to be used To add a New Diagnosis Read code and related Diagnosis Indication 1 Double click on the line of the relevant Indication or click the Codeset icon The Read Code Data Entry screen is displayed __ Codeset Codes MR ALEXANDER ROBERT MURDOCH 4 Lh J AE Cy i as T EEE me Comments gt Shoy ore Apply Priority Epizode Type Event Date Read Code Description Value Comments a a el cede A Se meee a co Aaa ea as He E E ree verre poner vee ena arr i eee re ee ee ee ee ee O32 201 4 4011 Recurrent pulmonary embolism Read Codeset 2 Place a tick in the Apply column If necessary change the Priority Episode Type and Date Recorded 3 Click OK to save 4 The relevant Indication is placed in the Indication area which is at the base of the screen 5 The Start Date will default to the date of the Read code entered but can be backdated if necessary by clicking in the down arrow and selecting it from the calendar 6 Where the treatment period is known an end date can be entered onto the End Date
7. more consistent because of this Never F adjust the dose yourself Never take an extra dose to catch up if you miss a dose If you miss a dose take it as soon as you remember up to i hours late If it is more than 12 hours late you should not take it and take your next dose at your normal time Check with your octor if you are unable to est for several 4 t History a INR 11 11 13 2 5 Dose 11 11 13 35 ma week lt gt Print Report 3 If you choose Print the report is sent directly to the prescription printer Select Print A4 to send the document to the Report printer Note You can only print this dosing regime report from the INR and Dose screen It is not available if you select Treatment Advice History or Trends 23 INR Tab The INR tab has been specifically designed for monitoring a patient s INR History Anticoagulation Pathway Warfarin ne _ Noacs Other Assessment VISION INR MONITORING INRA result 21 02 201 4 International normalized ratio 4 5 y F Target INA 21 02 207 4 Warfarin lower target 2 0 iL Patient informed of latest INF result Informed of latest INA result No Data Recorded L Nest planned INA test date F INR Monitoring e INR Results This information is automatically populated with the patient s INR results received from the lab Optionally the new INR value can be recorded by entering it into the INR measurement screen by selecting the INR value icon e Target INR S
8. 0 Indicator Logic 11 The Anticoagulation Pathway Tabs 11 Anticoagulation Pathway Tab 12 Warfarin Tab 14 Warfarin INR Diagnosis 15 To add a new Diagnosis Indication from an existing Diagnosis Read code 15 To add a New Diagnosis Read code and related Diagnosis Indication 17 Warfarin Dosing Tool 17 INR Tab 24 New Oral Anticoagulant drugs NOACs Tab Other Assessment Tab Summary Viewing or Adding Data to the Anticoagulation Template Anticoagulation Pathway Reports INDEX 24 25 25 26 28 Anticoagulation Pathway Overview As you may be aware Warfarin is the main Anticoagulation treatment for the prevention of stroke and thromboembolic conditions in certain patients with Atrial Fibrillation AF Recently published NICE National Institute for Health and Clinical Excellence draft guidelines permit the use of new oral anticoagulation drugs NOACs along with other risk factors their use is likely to be based on INR International Normalised Ratio control The Vision Anticoagulation Management Pathway contains tools for managing all aspects of anticoagulation regardless of the patient s drug regime It includes Adverse Event Reporting advice on Dosing regimes and presents supporting materials for structured Education and Reviews When you select a patient in Consultation Manager an alert window will warn if the patient is missing essential anticoagulation information that will assist in the management of their care
9. ailable than the one currently being displayed Where numeric data is recorded a graph is also visible Undo The Undo Last Entry icon deletes the Read code previously entered on that line during the current session Codeset The codeset icon takes you to the Read code data entry screen where Read codes can be chosen from pre defined list INR This icon allows you to add an INR result BMI Choosing this icon displays the BMI data entry screen and allows you to record the patient s BMI CHADS This icon provides quick access to the CHADS calculator screen Smoking Selecting this icon launches the smoking data entry screen and allows you to record the patient s smoking status Warfarin This icon launches the Warfarin dosing tool IMPORTANT You must select Save and Close if you have entered any information Anticoagulation Pathway Reports There is a comprehensive suite of pre defined Anticoagulation Reports built within the Vision Reporting Module From here you can work on patient lists or use the integrated mail merge facility 1 From the front screen on Vision go to Reporting Practice Reports and select the Other icon SIGN 5 h Oo Wi Practice Reports BR iy B Last Templates Attach Run Options Letters Practice Reports Other 2 Click Anticoagulation Pathway Reports Ta Other Anticoagulation Pathway Other Anticoagulation Pathway 26 3 The Reports
10. are Pathway PA Care Pathwar siti icon from the Toolbar a flow chart is launched Care Pathways provide extra guidance on how to manage the patient s care The Pathway option is available from all screens apart from History and Other Assessments 10 ANTICOAGULATION PATHWAY Author Dale Smith Email Dale Sn th ibluebaymedical co uk 3 Created 03 20 2019 14 FAHA MHS Board Biuefiy BlueBay GUIDELINES GUIDELINE RECOMMENDATIONS TARGET INR A target INF of 2 5 is recommended for a Venous thromboembolism VTE b Antiphospholipid syndrome c Abal fibrillation d Cardioversion higher target values such as an INR of 3 can be used for up bo weeks before the procedure bo avoid cancellations due bo s Mitral stenosis or regurgitation with atrial fibrillation of history of systemic embolism or left snai thrombus or enlarged left strum No Bioprosthesis in the mitral position g Bioprosthetic vaie and hisbay of oyster embolism h Boprosthetic walve amd left abrial thrombus at surgery iio Aieewreecthetic usher and other nevtherenhnbr riek fartore cork ac otrial Care Pathway To view further guidance on a specific area of the pathway click on any of the information boxes al on the flow chart and a panel will appear on the right hand side of the screen displaying additional guidance Some HB s CCG s have requested their local Care Pathways be incorporated into the Anticoagulation screen so you
11. are listed m i _a Print Print Cw Merge Preview File Catego Analysis Patient List Description Register COUNT 9 vw Description Patients who are being treated as part of an anticoag ABBOTT CATHERINE WINIFRED Description Patents recerving prescription for Warkarin in past 12 months COUNT 6 bdo S08 Description Patents who do not have a record of indication for anticoagulation with Warfarin COUNT 2 Description Patients who have a record of indication for anticoagulation with Warfarin COUNT 4 vw Description Patients who have a record of compliance with warfarin dosing instructions COUNT 1 ABEL ELIZABETH JULIE 03 01 1968 Female 4586730951 Description Patients who have not been advised regarding ther Warfarin daily dose COUNT 3 Description Description ociation with the use of W artarin COUNT 3 Description of target INA range Description Patients who do not have a record of INA test result in the past 3 months COUNT 3 Description Patients who have a record of IMA test result in the past 3 months COUNT 3 Description Patients receiving prescription for novel oral anticoagulants NOACs in past 12 months COUNT 3 Description Patients who do not have a record of indication for anticoagulation with NOACs COUNT 1 Yow Ww we Y Y Ww yY Y Description Patients who have a record of indication for anticoagulation with NOACs COUNT 2 Anticoag
12. aves the data to the patient s record Codeset The Codeset icon takes you to the Codeset data entry screen where Read codes can be chosen from a pre defined list Show Indicators This activates the Alert Indicator popup window Indicator Logic You can use the Indicator Logic tool to view the rule set logic behind the pathway Care Pathways This icon launches local national Care Pathway Default Date The date defaults to today but can be changed by entering a new or by choosing from the calendar Previous and Next Tab The previous and next tab toggle you through the tabs eg Anticoagulation Warfarin D Note If you right click on any line within a pathway you can access the same Toolbar functions Viewing or Adding Data to the Anticoagulation Template 1 In Consultation Manager select a patient and choose the Anticoagulation Pathway from the Alert Popup window or Vision from the Toolbar 2 Select Clinical Templates 3 To add data to a Pathway highlight the line and choose one of the Data Entry icons at the end of the line A summary of their function can be found here Summary Viewing or Adding data to the Anticoagulation Template page 25 T IMPORTANT All entries made to the Pathway should be saved by choosing the Save and Close icon If you do not choose save and close your data will be lost Care Pathway Care Pathways are built into the Anticoagulation Template When you select the C
13. box by clicking the down arrow and selecting it from the calendar If there is no End Date then it can be left blank 7 Click OK D Note Left click on the expand icon to view the description and details of each indication Current INR Warfarin Diagnosis Screen Need a section in here about how to change the diagnosis check with BB as cannot find an easy way Warfarin Dosing Tool From the Warfarin dose screen clinicians can easily monitor and calculate INR and Warfarin dosing respectively It can only be accessed when a New Diagnosis has been entered through the Warfarin screen See Warfarin INR Diagnosis page 15 It looks at the previous INR and dose history and calculates the new weekly dose It is split into four tabs The main INR and Dose tab is the one from where the calculation is performed D Note You must have five INR results in order for the dose to calculate correctly Is this correct 17 Viewing Current INR Dose This area of the Warfarin Dose screen gives details of the current diagnosis indication previous INR value and previous weekly dosing regime along with relevant dates The information in this section is for reference purposes only and cannot be changed Any data that is recorded into the patient s record is automatically populated on this screen EJwa rfarin dose MRS FAGAN PEARL DIANNE F Settings L Print Preview di Print d Print A4 Report a INA amp Dose Treatment amp Advice Histor
14. ding which colour tablets they need to take on which days The weekly Warfarin dose history is also displayed for the previous 5 values Contained within the report is general information 22 regarding taking Warfarin The report is designed to be printed out so that it can be given to the patient or any other clinician who may potentially need an overview eg If the patient changes practice 1 From the Warfarin Dose screen select Print Preview Print or Print A4 Report fa Warfarin dose MRS FAGAN PEARL DIANNE HE Settings 2 Print Preview A Print E Print A4 Report INR Doze Treatment amp Advice History Trends Print Options 2 If you choose Print Preview the report is sent to screen where it can be viewed and printed E Report Editor MR THOMAS COHBAN J M 01 Apr 2014 83 ti Tz A COHSBAN J M MR THOMAS 39 MEGSON DRIVE LEEDS Zz99 9ZZ L Dai ly dose commencing Monday 11 Nov 2013 next clinic date Monday 23 Dec 2013 Mon 5Smg 1 pink Tue Smg 1 pink Wed Smg 1 pink Tha Smg 1 pink Fri 1 pink Sat Smg 1 pink pun Smg 1 pink You must take Warfarin exactly as directed by your doctor If you do not understand these directions ask your pharmacist nurse or doctor to explain them to you You must always tell anyone treating you that you are taking Warfarin Always carry your anti ccoagulant card i with you It is important to take your warfarin at the same time every day your blood tests will be
15. e Anticoagulation Pathway Amalgamating QOF Alerts with Non QOF Alerts By default QOF alerts appear when you select a patient in Consultation Manager To amalgamate non QOF alerts eg the Anticoagulation popup window with the QOF window 1 Click the Vision lil icon and select Settings From Options tick the box Combine Triggers and click OK 3 The alert window will automatically show both QOF and other indicators when you select a patient You also see a new Combined popup fm icon on the Vision Toolbar D Note This is a ser specific setting Anticoagulation Pathway Alternatively you can access the Anticoagulation Pathway from the Vision menu or the F Vision icon on the Toolbar Select Clinical Templates Anticoagulation Pathway i BY Clinical Templates Anticoagulation Reporting Pathway TEST ONLY Basic Values Record Warfarin Monitor d EAP New Patent Registration Settings EAP New Patient Registration Screen Clinical Templates Anticoagulation Pathway An Overview of the Anticoagulation Pathway Screen The Anticoagulation Pathway displays the following screen Below is an overview of the functions available C V Training Tip Print this page and circulate it to anyone using the Anticoagulation Pathway 42 Home Appearance ie E i r H R O Pm A mem freteomee Sawe A Codeset Show Indicator Care j Previous Tab gf Next Tab Close indicators Logic Path
16. e events associated with Warfarin Any adverse events are displayed on this line or you can record new Adverse Events by choosing the appropriate Read code Note If you record an Adverse event or Allergy you are prompted to enter the drug when you save and close the Pathway Current weekly dose reported by patient This displays the patient s currently weekly dose Need to check what Read codes are used Adheres to medication regimen Select this box to record that the patient is adhering to their medication regime Check what is written back to Vision Warfarin Dosage WARFARIN DOSAGE Watain dose Warfarin dose using integrated dosing tool integrated dosing tool 21 02 2014 Warfarin dose 21 02 2014 Warfarin dose changed Click here to dose using INF Star dozing tool Patient advised about new dose _ No Data Recorded Select the Warfarin Dose icon There is a link to INR Star to launch the Warfarin dose screen Warfarin Dosage e Warfarin dose using the integrated dosing tool From here you can see the patient s current Warfarin dose and view the previous dosing history The previous INR results are displayed in a list or as a graph You can Read code the patient s warfarin dosage by selecting the appropriate Read code or view the Warfarin dose screen by clicking the Warfarin icon See Warfarin Dosing Tool page 17 e Patient advised about new dose Record any new dosage advice given to the pat
17. ed stop date in the Comments bos or if the patient requires life long anticoagulation therapy Freetext Planned duration of treatment O41 2201 3 Requires lifelong warkarin therapy ey guidance Anticoagulation therapy record issued updat No Data Recorded Anticoagulation Therapy e Prescribed Anticoagulants This shows the patient s latest anticoagulant medication The drug information is taken from the patient s therapy screen and includes all acutes and active inactive repeats provided the repeat has been issued You can also add a drug from this screen either as an acute ora repeat however it is not printed until you select print F9 from the Repeat Therapy screen For more information on adding a drug please refer to the Vision on screen help e Planned duration of treatment Specify the planned duration of treatment by choosing the appropriate Read code from the codeset screen The Read codes do not include a planned date so it is recommended that you add the planned duration of treatment or the stop date in the Comments box The stop date will not automatically inactive the medication this should still be done on the Repeat Therapy screen 12 Training Tip You may want to use the Patient Warning G icon on the Vision toolbar to record the planned duration of treatment Alternatively you could enter a Repeat Until Date when prescribing the anticoagulation medication For more information press F1 whilst
18. elect this box to specify the patient s target INR e Patient Informed of latest INR result This shows the last time the patient was informed of their INR result or you can add this information by selecting the appropriate Read code e Next INR test date This displays the patient s next planned INR date or select the date from the calendar or type the date What does the next box display New Oral Anticoagulant drugs NOACs Tab The NOAC tab is for new oral anticoagulation medication History Anticoagulation Pathway Warfarin INR Other Assessment 4 VISION NOVEL ORAL ANTICOAGULANT THERAPY Prescribed NOACs No Data Recorded k LL p NOAC Tab e Prescribed NOAC s From this area of the screen you can see what medication the patient is on and their NOAC history e Indication for NOAC s You can see the patient s latest diagnosis indication and the date the entry was made If there is no data recorded you can choose the Read code from the Data Entry screen Check what are the differences in the management of patient care the Read codes here are more operation specific and AF is shown but PE is not 24 e Adverse events associated with NOAC s Any adverse events are displayed on this line or you can record them by choosing the appropriate Read code D Note If a box is greyed out and not available it indicates that this information is not applicable to this patient Other Assessment Tab This tab e
19. gdon coefficient Target 2 2 to 3 2 5 Tablet strength Hospital J 5 ma Hospital Managed 3 mg 500 pg Patient INR Warfarin Settings e INR This section of the Settings screen specifies the INR target This INR Target range has a default value of 2 to 3 but can be altered if necessary e Tablet Strength The tablet strengths that are available to the patient can be selected under the Tablet strength area so consideration can be taken to enable the daily dosing value to be achieved from the tablet combinations available Where the weekly dosing regime is not possible you have a choice to round up or down The img tablet strength cannot be made unavailable to the practice as this is a most unlikely scenario e Hospital The Hospital Managed box should be checked if the patient is under hospital care eg admitted A marker is placed alongside the patient which can be seen on the Current INR and Dose screen in the Warfarin Dosing Tool INA amp Dose Treatment amp Advice Histon Trends Current INA and Dose Start Date Indication INA target 24 01 2014 Pulmonary embolus 250 IHR Date IHR 29 01 2014 6 00 Managed by hospital is displayed if ticked i Dose Date Wed Thu Fri Sat Sun sae if ticked in No Data Recorded ee Recall Date Mo Data Recorded Managed By The Hospital Managed by the Hospital Print Print Preview and Print A4 You can print a report which contains information on the patients dosing regime inclu
20. ient in this section Warfarin INR Diagnosis Before patients can have their INR monitored and Warfarin dose adjustment calculated they must first have a current Diagnosis Indication This is done on the INR Warfarin Diagnosis screen A prompt will appear when you select the Warfarin dose icon if an indication does not exist WARFARIN THERAPY 12 09 2013 Warfarin 1mq tablets y oY 04 02 2014 Atrial fibrillation due to thyrotoxicosis Adverse events associated with Warfarin A De Ut Current weekly dose reported by patient gt a a EE v ee Patient adherence Adheres to medication regimen O OK WARFARIN DOSAGE Warfarin dose using integrated dosing tool 21 02 2014 Warfarin dose changed 49 Click here to dose using INA Star dozing tool Patient advised about new dose adviged about new dose No Data Recorded ig LJ INR Warfarin Diagnosis Any diagnosis Read codes on the patient s record are displayed in the History column on the line of the relevant Indication The Read codes displayed can be selected and used as the Diagnosis Indication If a Diagnosis Read code does not exist in the patient s clinical record then this column will be empty and a Diagnosis Read code can be added very easily To add a new Diagnosis Indication from an existing Diagnosis Read code 1 Click on the History icon alongside the chosen Diagnosis Read code you wish to use 2 Double click on the relevant Read c
21. in Consultation Manager e Anticoagulation therapy record issues updated This is where you can view or record if the patient holds an anticoagulation therapy record Education and Review EDUCATION amp REVIEW 0171072012 Anticoagulation therapy discus LUIA Patient Advice Leaflet on Anticoagulants Click the link to view or print a patient Leaflet Annual anticoagulation review No Data Recorded Education and Review This section of the screen is where you can record education and review information It also includes a link to the Patient co uk website where you can print the Patient Advice Leaflet on Anticoagulants because you are accessing an external website the leaflet is not recorded in the patient s record e Anticoagulation Education This is where you can view and record when patient education is discussed To add a new Read code click the Codeset GL icon and select the appropriate code from the data entry screen e Annual Anticoagulation Review This is where you can view and record a patient s annual review To add a Review code click the Codeset GL icon and select the appropriate Read code from the data entry screen Note The Annual Anticoagulation Review is recorded as a History entry and not as a Recall Hospital Episodes HOSPITAL EPISODES Emergency admissions for anticoagulation No Data Recorded ca A Hospital Episodes e Emergency admissions for anticoagulation This box displays any an
22. ing Anticoagulant medication e Have one of the following indications Atrial fibrillation A mechanical heart valve Endocarditis Mitral stenosis Certain blood disorders Had surgery to replace a hip or knee Warfarin is indicate Pulmonary Embolism Inherited Thrombophilia PNH Paroxysmal Nocturnal Haemoglobinuria Cardioversion Coronary Angioplasty or Stents Coronary Artery Grafts Dilated Cariomyopathy DVT If the patient meets the above criteria the following options become available e Alert Popup window A prompt will show missing or incomplete data e Anticoagulation Pathway You can access the Anticoagulation Pathway clinical template Alert Popup To see the Anticoagulation popup alert window select the patient in Consultation Manager and choose the icon Show Other Indicators from the Vision Toolbar The Anticoagulation Pathway category is displayed in the alert box with any outstanding missing anticoagulation data listed below JAMRS FAGAN PEARL DLANNE we B Anticoagulation Pathway No record of INA test in the past 3m No record of duration of anticoagulation therapy Anticoagulation therapy record not sued or updated in past 12m Patient education not recorded in past 6m Anticoagulation review in past 12m not undertaken Anticoagulation Alert Window By double clicking on any line on the alert window or choosing the Template E icon from the Toolbar you are automatically taken to th
23. istory Anticoagulation Pathway Warfarin INR NOACs Other Assessment Anticoagulation Tabs 11 EJ Reminder To check what criteria is used select the Indicator Logic icons on the toolbar See Indicator Logic page 11 Check node message and why the indicator logic does not appear on the INR line Anticoagulation Pathway Tab The Anticoagulation Pathway tab shows the patient s current therapy and medication history From here you can record patient knowledge and annual review information as well as any hospital admission details Note The Anticoagulation Pathway can be printed by choosing the Print 4 i or Print Preview icon On Anticoagulation Pathway This area of the screen shows you when the patient was placed on the Anticoagulation Pathway or you can record the fact that the patient is part of the Anticoagulation Pathway On anticoagulation pathway anticoagulation pathway No Data Recorded i On Anticoagulation Pathway e On Anticoagulation Pathway This displays the date the patient was placed on the anticoagulation pathway To add the patient to the Pathway choose the Read code from the Codeset date entry LW icon Anticoagulant Therapy This part of the screen shows the patient s current anticoagulation medication and therapy history ANTICOAGULANT THERAPY Prescribed anticoagulants anticoagulants 12 09 2017 3 Warfarin mg tablets iLL Please record ether the planned duration of treatment or the plann
24. may see local guidelines displayed with details of their source The pathways are managed centrally ensuring that everyone in your local CCG HB is using the latest guidance Print or Save To print the Care Pathway click the Print Preview icon and choose your printer To save the Pathway as a PDF file click the Save ted icon Note What you print is what you see check this Indicator Logic Indicator Logic provides direct access to the conventions required to manage a patient on anticoagulation therapy You can view a graphical representation of the criteria behind the Indicator Anticoagulation Pathway by selecting the Indicator Logic 9 icon Tal Info Aa Show Al 4 Show Route Raat Antiooagulant lt 12m i o m Weartann lt 72m T Warfarin dose h a i Warfann dose Forward Date Enable Al Export Anticoagulant lt l2m Watain 12m Waifarin dose the latest Waran dose is later than or on the latest INA result a Indicator Logic Training Tip The Indicator Logic is displayed for the specific line highlighted The Anticoagulation Pathway Tabs Below is an explanation of each of the tabs within the Anticoagulation Pathway To add or view data to any of the screens use the Toolbar at the top of the Template or select the data entry tool at the end of each line a Summary of which can be found at here Summary Viewing or Adding data to the Anticoagulation Template page 25 l H
25. ode in the box that is presented 15 O Note You can only select one Read code 3 The corresponding indicator will then appear in the Indication section at the bottom of the screen with the Start Date set to that of the Diagnosis Read code 4 Where the treatment period is known an end date can be entered onto the End Date box by clicking on the down arrow and selecting it from the calendar If there is no End Date then it can be left blank this will be the case for the majority of patients Check as this End date is not shown anywhere in Vision 5 Click OK pjnew INR Warfarin Diagnosis El amp 3 wa Indication Target Grade History gt Pulmonary embolus mn Ai ee Ba 0202 2014 Pulmonary embolism woe gt Frosimal deep vein thrombosis 25 A hi gt Calf vein thrombus 25 A sa gt Recurrence of WTE when no longer on waran 2 5 A z gt Recurrence of YTE whilst on warfarin 35 C T gt Symptomatic inhernted thrombophilia 25 A Antiphospholipid syndrome 25 A gt Nor theumatic atrial fibrillation 20 A s gt Atnal fibrillation due to rheumatic heart disease 25 C hi gt Atrial fibrillation due to congenital heart disease 2 5 E T gt Atrial fibrillation due to thyrotoxicosis al E z Walvular heart disease 25 C hi gt Cardioversion 253 0 B hi Mural thrombus 2 5 B as gt Cardiomyopathy 25 E z Mechanical prosthetic heart valve 2 5 3 5 B z Bioprosthetic valve Y lchaemic stroke without atrial
26. ription F Start Date End Date Pulmonary embolus ummm OS 2O aeea Readcode T Event Date alue T Description T 420E 290172014 6 International normalised ratio 420E 05 01 2014 5 International normalised ratio 420E 01710 2013 amp International normalised ratio 420E 01709 2013 5 International normalised ratio Readcode Event Date Yalue F Description F BEL 4 eee Watain dose changed BEL 4 01709 2013 32 Watain dose changed Warfarin Dose History 20 Trends Tab The Trends tab is a good visual aid for looking at a history of diagnostic indications along with their dates it also shows the patients INR history and plots the weekly Warfarin dose with respect to time INF amp Dose Treatment amp Advice History Trends ohio T D T End Date F Pulmonary embolus 01 09 2013 International normalised ratio E Average 5 50 H ir O1NO2013 O5 012014 28012014 Warfarin weekly dose MB Average 32 00 E Warfarin weekly dose 0 7 O10a2013 W2N22013 Warfarin Dose Trends Note By default the data shown in the INR and Warfarin graphs are relevant to the current diagnosis To see a graph for other diagnosis indications highlight the relevant indication at the top of the screen 21 Settings Tab i _ Yigg Setting The Patient INR Warfarin Settings can be accessed from the Settings option es on the Warfarin Dose screen 3 wR Warfarin MRS FAGAN PEARL DIANNE IMF Hillin
27. t QOF alerts appear when you select a patient in Consultation Manager To amalgamate non QOF alerts eg the Anticoagulation popup window with the QOF window see Accessing the Anticoagulation Pathway page 6 e Add Diagnosis Indication Before patients can have their INR monitored and Warfarin dose adjustment calculated they must first have a current Diagnosis Indication See Warfarin INR Diagnosis page 15 e Entering Past INR and Warfarin Dose Values INR and Warfarin dose historical data must be available in the Pathway in order for the correct recall period calculations to be performed If the patient has more than five INR and five Warfarin readings then only the last five of each are used This information is populated from Vision and is available on the History tab within the Warfarin Dosing Tool screen See Warfarin Dosing Tool page 17 e Patient Settings To assist in managing the patient s Warfarin dosing regime you can set the patient s INR Target range and choose the tablet strengths that are available to the patient In addition you can specify if the patient is under hospital care which will place a marker alongside the patient For more information on Patients Settings see Warfarin INR Diagnosis page 15 Accessing the Anticoagulation Pathway To access the anticoagulation pathway functionality the patient must meet the following criteria The patient must check this is correct took it from a website e Be tak
28. ticoagulation emergency admissions To record new admissions select the appropriate Read code 13 Warfarin Tab This Warfarin tab shows the patient s current Warfarin dose history and Therapy information Embedded within the screen is a warfarin dose screen where you can record and calculate the patient s new INR regime In addition there is a link to the INR Star dosing tool Warfarin Therapy This section of the screen shows the patient s current Warfarin medication their warfarin indication and any adverse events 14 History Anticoagulation Pathway INR NOACs Other Assessment 4 Vision WARFARIN THERAPY 12 09 2013 Warfarin Img tablets x oY 04 02 2014 Atrial fibrillation due to thyrotoxicosis y 17 10 2013 Warfarin side effects ID 33 Gale Patient adherence 7 Adheres to medication regimen gs Warfarin Therapy need to change screenshot Warfarin spelt incorrectly Prescribed Warfarin This displays the patient s Warfarin medication You can add a new drug from this screen or a Read code indicating they are starting warfarin medication To record that the patient has stopped Warfarin click the Red flag Icon Note If you record that warfarin has been stopped this does not inactivate the medication on the Therapy screen Indication for Warfarin You can see the patient s latest diagnosis indication and the date the entry was made check that this is now picked up by a diagnosis Advers
29. ulation Pathway For more information on how to work on Patient lists or perform a mail merge press F1 in the Vision Reporting module to display the on screen help W Training Tip Select the Last Run option if you have closed the Anticoagulation Report down but now want to view it again 27 W index Warfarin Dosing Tool 6 15 17 Warfarin Tab 14 Warfarin INR Diagnosis 6 15 17 A Accessing the Anticoagulation Pathway e 6 An Overview of the Anticoagulation Pathway Screen e 8 Anticoagulation Pathway e 5 Anticoagulation Pathway Reports 6 26 Anticoagulation Pathway Tab e 12 C Care Pathway 10 Copyright Notice ii G Getting Started 5 Indicator Logic 11 12 INR Tab e 24 N New Oral Anticoagulant drugs NOACs Tab 24 O Other Assessment Tab e 25 Overview 5 5 Summary Viewing or Adding Data to the Anticoagulation Template e 10 11 25 T The Anticoagulation Pathway Tabs e 11 Toolbar and Data Entry Tools 9 28
30. way File Anticoagulation Manager for MRS ABEL ELIZABETH JULIE 03 01 1968 Ee Coniroks ANTICOAGULANT THERAPY Prescibed anicoagdants 0000 12 05 2013 Warfarin Timg tablets Please record ether the planned duration of beatment of the planned slop date in the Lomments box or if the paient requires 0471272013 Regane lelong walarn therapy therspy second invediupdet Mo Data Aecmded Ew CHEATERI Patent Advice Leaflet on Anticoagulants Leaf F Arria anticoagulation seview C2213 Annua watennaresment HOSPITAL EPISODES Na Data Fieconded P1 02 2014 Warfarin dose changed 44mg per week 49 y Previous Tab jf Net Tab An Overview of the Anticoagulation Pathway Toolbar and Data Entry Tools Overview of the Toolbar The Toolbar at the top of the Anticoagulation Pathway is used to access different functions within the screen some of which vary depending on the line you have highlighted It also provides links to local and national Care Pathways and the Indicator Logic tool can be used to review Pathway criteria O a A meaner Save amp Codeset Show Indicator Care i Previous Tab r Next Tab Close Indicators Logic Pathway File Controls Toolbar Toolbar Move Resize Minimise or Close amp Print Preview or Print To view or print the information Shaw icter mir dh Cae Patrraay Ta F on the Pathway Save amp Close This s
31. xplains other assessments which may affect the patient s dose History Anticoagulation Pathway Warfarin INR NOACs f Other Assessment 4 VISION STROKE RISK FOR ATRIAL FIBRILLATION a 1 J GENERAL HEALTH 0 26 3 NES I T l amp F P Other Assessment Tab e CHADS2 risk Score You can view the patient s latest CHADS score or use the CHADS icon to quickly access the CHADS calculator screen e Blood Pressure The patient s last blood pressure is displayed on this screen To view historical entries or add a BP use the data entry tools at the end of the line e Body Mass Index The patient s last BMI is displayed on this screen To view historical entries or add a BMI measurement use the data entry tools at the end of the line e eGFR results From here you can see the patient s eGFR results or add a new result O Note A Q in front of a line indicates that it is a QOF requirement Summary Viewing or Adding Data to the Anticoagulation Template From the Anticoagulation Template highlight a line and choose one of the following Data Entry icons at the end of the line Previous Entry This blue Blood Pressure Selecting icon indicates that the Lime this icon displays the blood patient does not have any pressure data entry screen previous records 25 Previous Entries When the row contains more than one relevant Read code a drop down arrow appears in red to alert you that more Read codes are av
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