Coumadin

Many offices will manage anti-coagulation patients at some point in time. There are workflows to accommodate managing these patients. Some things to consider are as follows:

Does the office have a separate schedule for anti-coagulation patients? If yes, then an Anticoag Note could be attached to the visit for ease of use.

1. Are the patients managed by an RN or a provider? If managed by an RN the note will need to be set up to be tasked for co-signature by a provider.
2. Is there a note set up for Anti-coag Management? If there is, then a flowsheet can be added to the results section of the note for ease of use.
3. Are the INRs done in the office as well as at off site labs? If done on site, these will need to be trended with the labs results. This can be done from within a flowsheet if set up properly.
4. How are paper INR results managed if done by an outside provider (not related to lab or the EHR)? This can be entered into the flowsheet also if set up properly.
5. What workflow was used prior to implementing the EHR? Has this been documented? The current state workflows will be the driving force developing the future state workflows.
6. Do all anticoag patients have an active order in the EHR for their anticoag medication? As a part of making dose adjustments an active order must be maintained, particularly when a nurse is managing the care.

Some Common Fields for Anti-coagulation Management Flowsheets:

• Indication for Treatment (picklist)
• Duration of Treatment (picklist)
• Goal Range (picklist)
• PT (manual entry and/or flow from interface)
• INR (manual entry and/or flow from interface)
• Current Med Dose (free text)
• Dose Change? (Y/N picklist)
• New Med Dose? (free text)
• Next Follow up? (pick list or free text)
• Comments (free text)