Galen eCalcs - Module: Anticoag Module
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.
Input Form
The input form is where users can enter data regarding the patient's current INR visit.
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.
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 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 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
- User enters the patient's "INR Overdue" date value.
- Patient's INR is not performed and documented prior to the INR Overdue data value.
- eCalcs will search the patient's chart nightly for a new INR value performed.
- 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