This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.

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2 This document is also available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) or (01224) This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. Title: Instructions for using the In-Patient Warfarin Prescription Chart in NHS Grampian Unique Identifier: NHSG/Inst/WPC/MGPG899 Replaces: NHSG/Inst/WPC/MGPG618, Version 1.1 Lead Author/Coordinator: Subject (as per document registration categories): Key word(s): Policy, Protocol, Procedure or Process Document: Document application: Purpose/description: Group/Individual responsible for this document: Policy statement: Principal Pharmacist (Clinical), Aberdeen Royal Infirmary Prescribing and prescription Warfarin, instructions, prescribing, administration, medicines, in-patient, prescription, chart Guidance Whole of NHS Grampian To promote the safe use of the In-Patient Warfarin Prescription Chart. Records Standards Group It is the responsibility of individual healthcare professionals and their line managers to ensure that they work with the terms laid down in this guidance and to ensure that staff are working to the most up to date guidance. By doing so, the quality of the services offered will be maintained, and the chances of staff making erroneous decisions which may affect patient, staff or visitor safety and comfort will be reduced. Supervisory staff at all levels must ensure that healthcare professionals using this guidance act within their own level of competence. UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG899 - i -

3 Responsibilities for ensuring registration of this document on the NHS Grampian Information/ Document Silo: Lead Author/Coordinator: Physical location of the original of this document: Job title of creator of this document: Job/group title of those who have control over this document: Pharmacist, Pharmacy and Medicines Directorate Principal Pharmacist (Clinical), Aberdeen Royal Infirmary Pharmacy Office, Aberdeen Royal Infirmary Principal Pharmacist (Clinical), Aberdeen Royal Infirmary Records Standards Group Responsibilities for disseminating document as per distribution list: Lead Author/Co-ordinator Principal Pharmacist (Clinical), Aberdeen Royal Infirmary Responsibilities for implementation: Organisational: Hospital/Interface services: Operational Management Unit: Departmental: Area: Review: Acute Sector Operational Management Team and Acute Sector General Manager Assistant General Managers and Group Clinical Directors Unit Operational Managers Clinical Leads Line Managers This policy will be reviewed in two years or sooner if current treatment recommendations change Responsibilities for review of this document: Lead Author/Coordinator: Review date: Principal Pharmacist (Clinical), Aberdeen Royal Infirmary Review 3 yearly. Any significant changes in evidence will result in earlier alteration. Revision History: Revision Date Previous Revision Date Summary of Changes (Descriptive summary of the changes made) Changes Marked* (Identify page numbers and section heading ) August 2017 November yearly update. August 2017 November grammatical errors. Introduction (page 1) August 2017 November 2013 Section headings added. Throughout document UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG899 - ii -

4 August 2017 November 2013 Minor amendments to prescription examples in line with updated Instructions for NHS Grampian Staff on the Prescribing and Administration of Medicines Using the NHS Grampian Prescription and Administration Record. All examples updated UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG899 - iii -

5 Instructions For Using The In-Patient Warfarin Prescription Chart In NHS Grampian Contents Page No: 1. Introduction Prescribing Guidance Prescription and Administration Record (PAR) In-Patient Warfarin Prescription Chart Discontinuing Warfarin Therapy Completing Discharge Checklist Warfarin Therapy Started Prior to Admission (Example 7) Warfarin Therapy Started During Admission (Example 8)... 7 Appendix A: In-Patient Warfarin Prescription Chart... 8 Appendix B: In-Patient Warfarin Prescription Chart (Long Stay) UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

6 Instructions for Using the In-Patient Warfarin Prescription Chart in NHS Grampian 1. Introduction This chart is intended to be used only for the prescription of warfarin to in-patients. This prescription chart requires that an entry be made detailing the warfarin dose for each day. This prescription chart should always be used in conjunction with a Prescription and Administration Record (PAR), i.e. main kardex. As with all prescription charts in NHS Grampian, this chart should be completed legibly in black ink and in BLOCK LETTERS. Note: There are 2 versions of the warfarin in-patient prescription chart, the standard version (Appendix A) and the long-stay version (Appendix B). Both charts should be completed using the following instructions. 2. Prescribing Guidance 2.1. Prescription and Administration Record (PAR) 1) Complete all necessary biographical details on the Prescription and Administration Record (PAR) (if not already done) according to NHS Grampian guidelines. Ensure the Known Medicine Allergies/Sensitivities box has been completed on the PAR and that there is no record that the patient has sensitivity to the drug which is to be prescribed. 2) In the Other Medicine Charts or Treatment Plans in Use section, ensure that the box is ticked indicating that the In-Patient Warfarin Prescription Chart ( Oral anticoagulation prescription sheet ) is in use (Example 1). Example 1: Other Medicine Charts or Treatment Plans in Use Entry UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

7 3) Prescribe warfarin in the regular therapy section of the PAR (Example 2). Example 2: Regular Therapy Entry 2.2. In-Patient Warfarin Prescription Chart (See Appendix A standard version, Appendix B long stay version and Examples 3 and 4 below) 1) Complete the biographical details at the top of the In-Patient Warfarin Prescription Chart Patient s name: Full name in BLOCK LETTERS. Date of birth: Written as, e.g CHI number: Patient s community health index number in full, e.g A printed patient label may be used for the above. Ward: Ward name should be written in full. Hospital: Abbreviations can be used, e.g. ARI. Consultant: Surname should be written in full. Allergies: Complete the allergy box/boxes if no allergies /sensitivities write NKDA in box 1. Date of admission. Prescription number record chronologically. 2) Indication select the indication for the patient being prescribed warfarin (tick box); if the indication is not listed state under other. 3) Warfarin on admission box complete if patient was taking warfarin on admission to hospital and complete the dose and intended duration. 4) New warfarin therapy box if warfarin therapy is new, select one of the regimes from the reverse of the chart and enter fast or slow, as appropriate into the box. In some specialist areas the senior doctor may specify a regime which is different from the fast or slow initiation schedules, in this case leave the box blank. UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

8 5) Concurrent medicines box if the patient is on any other medicine known to interact with warfarin (see current version of BNF), then please state here and specify likely effect. 6) Warfarin prescribing please refer to dosing regime selected if new therapy, otherwise clinical decisions on dosing should be made using the INR results and taking into account the warfarin dose on admission. 7) For each day s medication prescribed, the prescriber must complete: the date the INR result when checked the medicine, i.e. warfarin the dose in mg or withhold if no dose to be administered the time, usually 1800 a signature/print name. 8) In the Dose column, write the required dose to be given at that time. The smallest dose increments are 500micrograms (doses less than 1mg should be prescribed in micrograms do not abbreviate). 9) When administering the medication the nurse(s) involved should follow NHS Grampian guidelines for medicines administration and sign the Administered By section on the In-Patient Warfarin Prescription Chart. 10) If a dose is not administered, write an explanation in Administered By column, e.g. patient refused dose at Example 3: Patient Admitted on Warfarin 3mg daily Life-long Amiodarone increases INR 1/9/ Warfarin 3mg 1800 A Doctor A. DOCTOR A Nurse 2/9/ Warfarin 3mg 1800 A Doctor A. DOCTOR A Nurse UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

9 Example 4: New Warfarin Fast 1/9/17 Warfarin 10mg 1800 A Doctor A. DOCTOR A Nurse 2/9/ Warfarin 10mg 1800 A Doctor A. DOCTOR A Nurse 3/9/ Warfarin 10mg 1800 A Doctor A. DOCTOR A Nurse 2.3. Discontinuing Warfarin Therapy 1) When warfarin therapy is discontinued, two diagonal lines should be drawn across the administration record box and the date of discontinuation and prescriber s signature should be added. 2) The medication must also be discontinued on the Prescription and Administration Record (PAR) (Examples 5 and 6). Example 5: Discontinuation of Other Medicine Charts or Treatment Plans in Use Entry UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

10 Example 6: Discontinuation of Regular Therapy Entry 3) The In-Patient Warfarin Prescription Chart should be filed in section D of the patient s medical notes. 3. Completing Discharge Checklist The discharge checklist should be completed on or before discharge. Whilst some parts of the checklist can be completed during the admission, the whole section should be reviewed on discharge by the healthcare professional discharging the patient Warfarin Therapy Started Prior to Admission (Example 7) 1) All patients must be given an anticoagulant pack if they haven t received one in the past. 2) The recording (yellow) booklet must be completed detailing the doses given during admission and the INRs recorded. 3) The patient/relative/carer must be aware of the doses to be taken and when and where the next INR check needs to be done. Example 7: Warfarin Therapy Started Prior to Admission Brought book in Done previously Yes 1/9/17 Yes 1/9/17 N/A INR check 3/9/17 GP A Doctor A Pharmacist A Nurse UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

11 3.2. Warfarin Therapy Started During Admission (Example 8) 1) All patients must be given an anticoagulant pack containing information on warfarin and a recording book and alert card. 2) They should receive full counselling on this new treatment. 3) The recording (yellow) booklet must be completed in full detailing the doses given since therapy started and the INRs recorded. 4) The patient/relative/carer must be aware of the doses to be taken and when and where the next INR check needs to be done. 5) The patient s GP surgery must be contacted to ensure they are aware of a new patient on warfarin. Example 8: Warfarin Therapy Started During Admission Yes 1/9/17 Yes 3/9/17 Yes 5/9/17 Yes 5/9/17 Yes 5/9/17 INR check 7/9/17 GP A Pharmacist A Pharmacist A Doctor A Nurse A Doctor A Nurse UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

12 Appendix A: In-Patient Warfarin Prescription Chart UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

13 Appendix A (continued): In-Patient Warfarin Prescription Chart UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

14 Appendix B: In-Patient Warfarin Prescription Chart (Long Stay) UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

15 Appendix B (continued): In-Patient Warfarin Prescription Chart (Long Stay) UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG

16 Appendix B (continued): In-Patient Warfarin Prescription Chart (Long Stay) UNCONTROLLED WHEN PRINTED Review Date: August 2020 Identifier: NHSG/Inst/WPC/MGPG