Dosing Warfarin: From Flowsheet to Workflow. Is This Progress?

Warfarin dosing requires viewing past values and past dosing. If every time a certain dose change results in an unwanted result, we should probably avoid making the same over- or under-correction again and again.

For many years I have used a paper(!) flowsheet that takes seconds to utilize and gives a practical overview. These sheets sit in a three ring binder. My nurse can flip through this binder and spot who is delinquent with their testing. The actual lab values are of course in the computer, but so far the three EMRs I have used can’t give me the overview I need within anything even close to a reasonable timeframe.

These two pictures say it all. My patient in the paper flowsheet has a home INR that requires weekly testing for the insurance to cover it. The “workflow” (how I dislike that word) on the bottom is from Epic.

I thought computers had the capability of speeding things up, but in my corner of the world that is mostly a pipe dream.