Galen eCalcs - Module: Anticoag Module

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Description

The Anticoag Module is designed to help clinicians begin anticoagulant therapy for patients by estimating the necessary dosage. The tool can also be used to track a patient's therapy over an extended period of time. Due to its robust design, the Anticoag Module has a separate tab in the HTB within TouchWorks. The module is broken into 3 sections; a collapsible flowsheet, an input form and an output table.

Flowsheet

The flow sheet within the module is a way for clinicians to view the patient's history without having to click back and forth between the module and clinical desktop. The flow sheet is collapsible for convenience. The filter option allows users to filter by 1 month, 3 months, 6 months or all visits.

Anticoag - Flowsheet.JPG

Input Form

The input form is where users can enter data regarding the patient's current INR visit.

ACInput.JPG

Data Fields Explained

The following table explains each data field and it's functionality.

    Fields that are carried forward will contain the same value from the last visit.
    Fields that are required will be bright yellow with a red asterisk next to them indicating that they must be filled out to commit the information.
Name of Field Functionality Carry Forward? Required Field?
Systolic Blood Pressure The patient's most recent Systolic Blood Pressure value No No
Diastolic Blood Pressure The patient's most recent Diastolic Blood Pressure value No No
Heart Rate The patient's most recent Heart Rate value No No
INR A free text field to document INR value Yes Yes
INR Result Date Date value associated with the INR value Yes Yes
Goal INR INR Value ranges that are considered healthy for the patient Yes Yes
INR Relative to Range Indicates where the patient's INR falls in comparison to their Goal INR No Yes
Indication For Therapy Why the patient is receiving therapy Yes Yes
Indication Comments Free text field for comments regarding therapy. Limit - 250 characters Yes No
INR Complications Any complications the patient experienced No No
Treatment Duration Indicates the length of therapy Yes Yes
Start of Therapy Date field indicating the Start Date of INR therapy No No
Supervising Physician The patient's current dosage Yes No
Current Total Weekly Dose A text input for the patient's current dosage Yes Yes
Anticoagulant Name The name/type of anticoagulant Yes No
Tablet Strength Multiple dosage strengths can be selected Yes No
Hold Notes Free text field for comments regarding discontinuation. Limit - 250 characters No No
Change Dose A Yes/No field indicating if change in dosage is necessary No Yes
Next INR The patient's recommended next visit date No Yes
Next Appointment Date field for indicating patient's next INR therapy visit No No
INR Overdue Date field for indicating when the patient's INR value is overdue No No
New Recommended Total Weekly Dose Auto-calculates the patient's new weekly dosage No No
Non-Compliance Risk Patient's level of disobedience No No
Bridging Indication and Comments Check box and comments field. Limit - 250 characters Yes No
Internal Comments Free text field for any additional comments; will be pulled into the provider summary print out summary No No
Patient Instructions Additional instructions for the patients, will be pulled into patient print out summary No No
Medication Interactions A text field listing potential (mapped) INR therapy drugs the patient is currently on No No

Weekly Dosage Table

The weekly dosage table will initially display the patient's previous dosage per day. When "Change Dose" is changed to "Yes" in the input form, the weekly dosage table will allow users to manually update/enter the appropriate dosage amounts the patient should be taking daily.

Anticoag - Dosage Table.JPG

Module Outputs

The Output table is a summarized version of the information entered. Towards the bottom of the output table, there are three buttons:

  • Show Summary: This button can be selected at any point during data entry to view the summary of information in the output table.
  • Commit: By selecting this, the information will be saved to the patient's chart and added to the flow sheet.
  • Commit and Print: This button will save the information to the patient's chart and prompt the user to print out a Patient Instructions print out.

Anticoag - Output.JPG

AntiCoag Patient Instructions - Print Out

The print out is an instructive form the patient can use as a reference between visits. The print out contains the following fields:

  • Date of INR Test: The date recorded in the module as the date of their current test
  • Your INR Results: The patient’s current INR value
  • Your Goal INR Range: The INR range they should fall into
  • Total Dosage per Day: The amount of milligrams per day the patient should be taking.
  • Patient Instructions: Any additional instructions given to the patient
  • Next Lab Visit for INR: The date of their next visit.

Anticoag - Print Out.JPG

AntiCoag Provider Summary

INR Follow Up Tasking

Tasks are generated when a patient's INR visit is past due. There are two task driven workflows and configurations to potentially adopt within the AntiCoagulation Module.

INR Overdude Date

Configuration Prerequisites

  • Configuration Option - Late INR Task Priority Name
  • Configuration Option - Late INR Task Type Mnemonic

Workflow Behavior

  1. User enters the patient's "INR Overdue" date value.
  2. Patient's INR is not performed and documented prior to the INR Overdue data value.
  3. eCalcs will search the patient's chart nightly for a new INR value performed.
  4. When a performed INR value is not found, a task type "INR Follow Up" will be generated.

Additional Resources

References

https://web.archive.org/web/20140823095414/http:/www.pace-med-apps.com/CoumCalc.htm