PRACTICE POINT

AUDIT POINT

• Objective test for diagnosis e.g. of venous thromboembolism

• Appropriate investigation results documented e.g. ultrasound scanning and/or venography for deep venous thrombosis; chest x-ray and ventilation/perfusion scanning for pulmonary embolism

• Baseline investigations.

• Results of coagulation screen; blood count including platelet count; urea and electrolytes; liver function tests.

• Risk factors for anticoagulation

• Age, past history, drug history recorded

• Start warfarin on day one of heparin administration (or confirmation of diagnosis).

• First dose of warfarin on first day of heparin (or confirmation of diagnosis)

• Overlap heparin and warfarin by 72 hours

• Both heparin and warfarin prescribed concurrently for three days

• Use algorithm to predict warfarin dose

• Agreement of initial warfarin dose with that predicted from algorithm

• Stop heparin when International Normalised Ratio (INR) within therapeutic range for two days

• INR within target range for 2 days on day heparin stopped

• Measure INR daily and at discharge

• INR documented on each day of treatment; INR within target range on day of discharge; INR on day of discharge; time to achieve INR in target range

• Anticoagulant management plan

• Planned duration of anticoagulant treatment documented; target INR and range specified

• Book appointment at anticoagulation clinic

• Clinic appointment documented

• Arrange interim INR if more than four days to clinic appointment

• Arrangement for interim INR documented