St John of God Subiaco Hospital - Aim of the Anticoagulation Medical Chart

3. Caution Warfarin The regular medication chart HR810 MUST be annotated to identify when an anticoagulation chart is in use Place sticker in a “Regular” medication section of the Medication Chart HR810

4. Patient details – Page 1 Record all Alerts, including those related to anticoagulants on the Regular Medication Chart (see also prescription screen). If any Alerts recorded affix a RED ALERT sticker here.

8. Variable dose orders Note Warfarin dose time 1600 NOT 1800. Now agreed time in Western Australia - pre printed Check the route Dr to complete prior to discharge 3 mg 2-3 3 months Complete prior to discharge Don ’ t forget

11. Intravenous infusions 1 2 3 4 5

12. The SJOGHS therapeutic target ranges Maintenance regimen Maintenance regimen Initiation regimen Initiation regimen Venous Thromboembolism Acute Coronary Syndromes

13. Weight based guides –valid for standard solution 50 units/mL Weight based guides Venous Thromboembolism Initiation regimen Maintenance regimen Acute Coronary Syndromes Initiation regimen Maintenance regimen

15. Prescription order  Standard solution – is pre-printed If not applicable Doctor to cross out and document as appropriate eg Glucose 5%. Weight based nomogram guides are only applicable when the standard concentration of volume is used Document target aPTT Weight based nomograms only applicable with STANDARD aPTT therapeutic ranges 60 -90 Document indication Document actual patient weight 74 kg

16. Initial bolus dose and infusion rate Page 2 14/5 14/5 0200 The aPTT must be checked within 6 hours of initial dose Page 3 45 Document as soon as available 6000 27

18. Maintaining the infusion regimen using the weight based nomogram and weight based guide 0830 30 27 + 3 MV GH 1430 25 30 - 5 KJ MN 14/5 0800 55 3000 0830 MV/ GH 14/5 1400 110 14/5 2000 85 2030 25 PO MG

20. Infusion bag changes This extra information will assist monitoring actual doses delivered 1800 Document the time the bag was changed/stopped. 480 ml Document volume infused. (Total volume minus volume remaining) 14/5 1800 0200 14/5