<This lunchtime our practice nurses and reception staff had the opportunity
to tell us how much extra work, grief from patients and general hassle they
had incurred, as a result of the partners' bright idea of using a computer
program to handle Warfarin monitoring.
It's now been 3 months and still the extra workload of phlebotomy and
explaining to the outraged punters why their precious dose has changed again
is not abating.
Does anyone out there have any insight into when things begin to get better,
as the computer builds up it's database and starts calling people back less
often for blood tests?
At the moment we're in the ludicrous position of using GP's time to help
with the extra phlebotomy workload! Any suggestions gratefully received.>
It doesn't have to be like this!
1) Don't do anything without proper funding. INR monitoring is
traditionally a secondary care activity. Typical hospital price = 30+
charged as a haematology follow up. Can be done profitably in primary care
for 10 per contact. This includes payment of phlebotomy and lab costs. If
the HA refuses to play ball it is their loss not yours. NO MONEY NO
MONITORING.
2) Put the computer in a locked, dark room. Work out the dosage yourself in
conjunction with the nurse. This will be more efficient and reliable, at
least initially than relying on a computer programme.
3) When everything is running smoothly try out available computer software
software - RAT and INRstar are well presented packages. I have been trying
out both and have been disappointed by the results so far. I think the
underlying programmes are too crude. We are aiming for 70% of results to be
within range. Neither of the above appear able to achieve anywhere near
this.
Our clinic is running with minimal hassle, high patient satisfaction and
profitably. We have about 100 patients on warfarin.
I have recruited mathematical support to devise a better computer based
calculation. Testing at present.
Martin Bradley
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