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DAWN AC Version 7 User and Safety Manual

1. Pr Adding a New SU e Das Adding Editing a Message Template Listor Message Template S iei eti Ios cero coena aaa E cro Adding a New Message Template 31 nennen nnn n nnn nn nnn nnn n nnn Adding Editing a Message 2 1 List of Message Events crecer cuiii iicet ciere eee cea conva aio s Sae r sau epe aaea ehan Adding a New Message Setting up a Cessation 2 2 2 List otl Cessation Choosing Cessation Reason Application Area Cessation DCLIezedi M Editing System ocu edes Quc teen DUE esM UI DE EDEN Accessing the Clinic Diary 5 ee List Views What are They hiec DeaHISrlg cwm LIS VIEWS c
2. 246 Miss and Boost Days with Multi Tablet Instructions 1 1 12 11 248 DOSING FES TORY EE LIE a 249 Preventing dose calculations based on inappropriate doses 251 Retrospectively Adjusting the Last Dose 111 22122 1 1 1 1 1 2 2 4 252 INGUCTION DOSING eee c 255 Dow nloading and Importing Default Induction Regimes 258 Inductorndoss a Nro de 261 Including Instructions in Message Tem plates 262 Contents 9 Permitting or Prohibiting Custom Instructions 11 1 212333111111 eere eere eene 263 Plain Text Non DayPattern Instructions 1 1 111113113113 264 Customising Plain Text Non Day Pattern 265 Day Pattern Instructions compatibility mode
3. 107 Adding Editing M MERERI EE LE 107 Erga il oet 109 Adum NeW cip M 110 16 Adding Edi ng Procedures iate an vis extis ac Ge GU dp e 110 LISTO POCO dU BS eene n LESE ea 112 Adding a New Procedure 113 19 Adding Editing Diagnosis Groups 113 LAST OL DIAGNOSIS GhOUDS p 115 Adding New DiaGnoOsiS GrOUD 116 2014 6 Dawn Version 7 E Manual 20 21 22 23 24 25 26 Part X Part XI 2 Part XII 1 Part XIII Part XIV 1 2 Part XV 1 2 Part XVI Adding Editing Diagnosis 2 1 Listor DIAGNOSIS cedro peas eo enis Adding a New Diagnosis Adding Editing 2 2 et Adding a New 2 Adding Edi ng 2 222 022222222009
4. None selected Treatment AllowScheduleTreatment High AllowUnSchedule Treatment High AllowEnterAndAccept INR High AllowDNA Treatment High AllowTestFailedTreatment Hight AllowAcceptDose High AllowAuthorise High Allow AuthoriseManualBridgingTreatment 2858 AllowResetTreatment High lt AllawtustomizedWeekPatterns Visi AllowEdit isit AllowSchedule isit AllowUnSchedule isit AllowDNAVisil AllawtloseVisit AllowDeleteVisit Patient interventions patient results AllowEdiEPatientIntervention None None selected poner coun AllaowAddPatientIntervention None selected 2014 Settings for DAWN AC lAccess to parts of the application Allow viewMenu AllowReports AllowEditReports AllowMessageCenter AllowClinic iew AllawtlinicDiary ShowStatisticsOnBackPage Admin functions AllowViewAll rganisations Allawliser Management AllowMaintainUserProfiles AllowMaintainDosingEngineT ables AllowMaintainSystemtT ables AllowMaintainMedicallookupTables AllowMaintainOrganisationT ables AllowSystemTools Allow viewAuditT ables AllowMonitorScreens e xc e Be Se e Be oe EA e Application Area specific permissions Allow Access Anticoagulation Healthcare professionals in this profile HCProfessionalT ype L SEE Big Hospital Support Other OrderM
5. 2014 Dawn Version 7 E Manual 9 7 2 Adding a New Healthcare Professional x s m DE cu Er Dutton and return 98 Adding a New Healthcare Professional Healthcare Professionals can be added to the DAWN system and can optionally be set up with user accounts to access their patients Once healthcare professionals have been added to the system they can be logged as a patient s referring GP consultant etc 2014 Settings for DAWN AC LicenseAgreement Welcome License MaxActivePatientCaunt _ Fou are currente logged on Support 45 with user porohe Top orade Frontpage i Normal Tables i ME HealthAuthority D W N SU Organisation FRAME e ward HCProfessianal Clinic PatientGraup Patient view LodinLog add edit or dose a patien Clinic diary Meeting List view Daily rc MeetingTemplate attendance and non attenc Test ReferenceRange Diary estaroup Consult the diary Therapy Template e Trial Message center amp DrugTemplate Manage messages and pas Questionnairelype GeneralLookupCategory Reports Team Custom reports Lookup tables Reports PETER 2 2 Settings An Organisation must be created before a Healthcare Professional can be added 2014 Dawn Version 7 E Manual 9 8 1 List of Healthcare Professionals 1 Search f
6. in clinic Anticoagulation Clinic Reschedule manually Phone home No warnings Age 66 ed PERIPHERAL VASC BYPASS GRAFT 2 0 3 0 2 5 Target 10 MG WEEKLY DOSE 01 03 2009 Indefinite 4 1 b ofi active Treatment notes Status Schedule H Accept INR DNA 2 Graph Personal Prime Comments NI Wed 01 07 2008 0 0 0 00 w if Thu 11 06 2009 2 1 20 00 t 2 wk Tue 14 04 2009 2 3 70 00 w Tue 07 04 2009 2 6 70 00 w if Big Hospital Support 4S another note to try GS Gs Gs Gn Gams 6 13 Dawn Version 7 E Manual 23 1 23 2 Confirm DNA Selection PyeDelia 11 01 1943 2344 Risk class Drugs Scheduled For Thu 25 06 2009 09 00 17 00 in clinic Anticoagulation Clinic Reschedule manually No warnings Pref clinic Anticoagulation Clinic 12345 Phone home v 66 et ie ge PERIPHERAL VASC BYPASS GRAFT 2 0 3 0 2 5 Target WARFARIN 10 MG WEEKLY DOSE 01 03 2009 Indefinite Treatment notes dose zero Status Scheduled uua 4 1 b of 1 active Big Hospital Support 4S another note to try Patient Non Attending PyeDelia 11 01 1943 2344 Risk class ae f Date 01 07 2009 Mot scheduled coe
7. ee d io TERMINAL CARE Moderate No Hospitalisation lt Always warn 5 VERY DEAF Moderate Hospitalisation Always warn X 9 12 3 Risk Class A risk class can be chosen for a patient to indicate what their risk level is e g high risk low risk This risk class appears on the top left of the main patient screen Risk Class options can be added edited from the Lookup Tables on the F5 menu 2014 Settings for DAWN AC 95 RiskClass Description Risktevel olortode InUse obre fw J C K pedm sjsrex 5 ban 5 9 13 Adding Editing Allergies If you need to add an allergy that does not exist in the standard list new allergies can be added here 2014 Dawn Version 7 E Manual LicenseAgreement license MaxActivePatientt Frontpage Normal Tables i CLINICAL Lookup tables DZ LLIS L Rat Anticoagulation Tables RAMEVWWORMK aged on Sunnort 45 with wer praise Ton Grace Sllergy ae BloodGroup Diagnosis Drug Dru gInterackion EthnicOrigin Antica Patient view Add edit or dose a patient Event List view Daily routines HCProfessionalType attendance and non attendance JournalltemType Lette
8. for e Scroll down to the Printers section 16 Dawn Version 7 E Manual Printers i 2 e Microsoft XPS Document Writer Microsoft XPS Document writer e Microsoft Office Document Image Writer Microsott Office Document Image Writer edc WColour Wedded wolar e Wedc 1 HP Business Inkjet 1200 Series wdsdclHP Business Inkjet 1200 Series e Weedced HP 2520 PCL 6 Black hite Wedced HP CLJ2520 PCL Black hite Wedel hp LaserJet 1320 PEL Wedel hp LaserJet 1320 PEL 1 1 1 1 x e Select a printer from the list of printers in print station interface This will display the interface used to map a printer with printer paper type Printer dawnmailer Micrasaft APS Document writer Microsott APS Document writer Microsoft Office Document Image Writer Microsoft Office Document Image Writer ede Colour Wedel Colour Whede HF Business Inkjet 1200 Series dzdc1 HP Business Inkjet 1200 Series WdzdcliHP CLJ2820 PCL 6 Black White wd4sdc1 HP CLJ2820 PCL Black vwhite amp TIT gt Matsdcicalour DeviceName W45de1 Colour RAM PrinterPaperType None selected Orderhr None selected PrinterLocation e Select the PaperType from the drop down list e Choose Save 16 5 Setting Up a New Printing Location e In DAWN AC press the F5 key to display the menu on the left of the screen Select e Normal Ta
9. Step 1 Patient Details 0 Y Y Y Last name Ethnic origin None selected First name Primary language Mane selecked Sex Mane selected an i Home phone Title obile phone Date of birth I Age h jon the Work phone Hospital Number number Email address National No Address 1 Address 2 Risk class Hc Town County ou will need to save this new record before you can add related Postcode ecards Notes he z Previous step 2014 178 Dawn Version 7 E Manual 18 1 2 Wizard Screen Entering Treatment Plan New Patient Wizard n m Step Mc Tenen Plan Details Disease area Anticoagulation Primary diagnosis Date of referral FER Physician None selected Target range None selected Induction algorithm Mone selected Start date 30 11 2009 Duration Weeks Days Transport needs Motes First seen date Preferred clinic Preferred time Next test date ae RR Dosing limits Laboratory da MaxPercentDoseChange MaxInterval 7 Set the status of the TreatmentPlan to Admitted E Set the status of the TreatmentPlan to Active Admitted Requires and Duration type Decide later kin clinical or contact details Next step gt 18 1 3 Wizard Screen Next of Kin Details New Patient Wizard
10. Disease area Anbeosouistion Primary diagnosis A4FNR Atralfbrilatonnonvah Date of refe AC Therapy C indu Referring GI Target range Regime Start date Duration type Duration First seen date Preferred clinic m Preferred time From TO Next test date HaxInterva Laboratory None selected Set the status of the TreatmentPlan to Active Requires a Diagnoss Targe 2 Activate a treatment plan 2014 New Oral Anticoagulants non VKA Section EUM List view Patient x Watters Wilma 04 09 1912 33243434 4 The Squar Dy Risk class Low Pref dinic None selected du 8 This therapy is managed using Questionnaires Age 100 To schedule a questionnaire x trial fibrillation nonvalvular DUE 1 Pressthe button on the Questionnaires 2 Set the status to Scheduled 3 Set the due date as appropriate n I RINT EE NR S 0 Questionnaires St Elsewhere Support Dawn Referring GP updated to 5t Elsewhere support Dawn 3 Schedule a Follow up questionnaire section 4 3 The essential choices on a DAWN AC treatment plan are e Primary diagnosis must be listed as a therapeutic indication for the non VKA anticoagulant agent contact your system administrator if you have problems activating your treatment plan 2014 am Dawn
11. Mon 27 07 2000 2 5 28 50 wi Mon 20 07 2009 25 28 50 wii L gg GE E E ER 2014 Frequently Asked Anticoagulation Questions 363 26 Frequently Asked Anticoagulation Questions Some frequently asked questions are listed below Click on the question to read the answer How can undo a dose within DAWN AC A patient calls and wants a different next test date time How do reschedule them have authorised a patient dose but now need to change the patient s next appointment to attend another clinic How do do this A patient has had their warfarin stopped reduced for an upcoming procedure How do manage their INR records 26 1 How Dol Undo a Dose How to undo the INR or dose depends on whether you have already authorised the dose for a patient or not If you are still at the stage where the dose is not authorised e g a dose and next test has been suggested the Accept Dose button has not been clicked then you can undo the record by clicking on the backwards facing arrow to the top right of the dosing box Dosing Contacts Letters Drugs Events Procedures 7 Reviews Reminders Groups Documents Owners Account INR 3 4 High Y Sun Pon Tue Wed Thu al NET MT NT Eit 315 Em a Dose decreased by 11 Status Tested Next 21 10 2009 7 d If the dose and next test date have already been authorised and the next test
12. denote size and Wed 22 07 12003 50 00 w 1 3 wk direction of change Wed 08 07 2008 21 S000 waa M 2 wk Wed 0109 2009 26 5000 L Missed tablets for las Fri 25 05 2018 24 5000 wea 6 wk Fri 1305 2009 26 2000 wif wk 4 14 04 2009 26 2100 wil Wed 08 04 2009 21 21 00 07 04 2009 27 2100 wi Mon 04 2009 21 21 00 w d 1 The dosing instruction appears in the Dosing Panel as a formatted table If the instruction is expressed in tablets the instruction includes a line for each tablet strength used in the regime If it is expressed in mg it comprises a single line 2 Instructions expressed in tablets show a line caption text and an image for each Tablet strength Instructions in mg show a fixed caption of mg and no image 3 If you have specified the brand a Regime uses the Display Name for the Brand is displayed at the top of the instruction e g warfarin for the UK generic brand or Coumadin for the Coumadin brand Where a brand has not been specified for a Regime e g a regime expressed in mg the Anticoagulant name is displayed 4 If an instruction is expressed in Tablets the AC_ShowinstructionTotalDoseLine system setting determines whether the Total mg line is always displayed or only displayed if an Instruction includes Tablet Strengths of more than 1mg A Regime setting can be used to override the AC_ShownstructionTotalDose
13. 6 wk Y If your instructions still display as plain text they are likely to be non day pattern instructions See Working with Dose Instructions Plain Text Non DayPattern Instructions To print formatted instructions you need to make the changes to your Message Templates described in the following section 25 6 6 Updating your Message Templates If you make no changes to your message templates they continue to display a plain text version of your dosing instructions If you switch off compatibility mode the layout change slightly See section Working with Dosing Instructions Including Instructions in Message Templates for full details Itis possible to display the formatted HTML style instruction in your MessageTemplate instead of the Plain Text Version for example Take 0 00 for 2 days then sun mon Tue wea mu sat _ 2 2 2 2 Tablet 1mg Tablet 5mg 2 1 Total mg 2 2 2 2 9 1 2 however this requires a change to your MessageTemplates Please contact 4s DAWN support for help if you would like your message templates to display formatted HTML instructions 2014 a54 Dawn Version 7 E Manual 25 6 7 25 7 25 7 1 Tel 44 0 15395 63091 support 4s DAWN com Permitting Users to Customise Instructions Following the instructions in the preceding sections ensures your Day Pattern instructions display and print in the formatted HTML format However
14. 435 indications ioia 437 Qualifying Risk Factors Tor non VKA 437 Interacting drugs for non V cose eran usan Eco AE pan aah E 438 Specific RISKS for noli VKA 439 Regime and Non VKA DOS niece cce cc iiii emen eo aranea ce rero io orant nona nean a ese a corno Sr aoa 3 ax Oa Ora c arua aa E Ra ER Eire 439 General Lookup Category settings for non VKA 441 Enforcing Mandatory Use of the NHS Number 444 OVETVIEW Ve iuc de ade eb edet eds 444 Switching on NHS Number 0 ne nnne nnn 446 Changes to the Patient Screen when you Enforce Compliance 448 Changes to the New Patient Wizard when you Enforce Compliance M P MEE 452 Changes to the Patient Search
15. Sorting By Type Name Last changed Search for Name AC DisplayDosing Value 21 SERRER Customizations UL 5 DisplayDosingInstructions ShowTotalMgInDecimals Should the Total Mg ec of a dosing instruction always be displayed in decimals regardless of whether the tablet lines are shown in fractions 0 1 DisplayDosingInstructionsInDecimals b Must the AC I be displayed using fractions 0 or decimals 1 5 Change the Value of the setting to the required value 6 Press the Save button or simply close the form changes are saved automatically when 2014 Settings for DAWN AC you close the form 2014 Accessing the Clinic Diary 139 10 Accessing the Clinic Diary You can view the names and numbers of patients booked into a particular clinic on a particular day by looking at the Clinic Diary 9 License MaxActivePatientCeunt Fou are currency logged an Support 35 wh user profile Tao Grade CFrontpage gt Pee eee Normal Tables 7 AW N Organisation F 1 4 e ward HCProfessional Clinic PatientGroup LoginLog Anticaaqul Patient view Ca Add edit or dose a patient Click here bo view the Clinic diary J clinic diary Meeting z List viewl MeetingTemplate attendance e Test Diary Consult the diary
16. esses 265 4 Setting Up Regimes and 0 21 267 Anticoagulants Tablet Strengths and Brands 42421222224 nennen niente nnne nnn nnn 267 AnjcoagulaM CR 267 Creating New Anticoagulant Record ssssssssssssseseeennnnn nennen nnne nnnm nnne nnne nnns 269 Soe eo ae 271 Creatng BI aluo et Der date re b le 272 Table PSIEODIOLHS 273 Creating a Tablet Strength record sse nnn nnn nnns 275 277 CrEAUMG a ELS 277 Creating a Regime Expressed in 0 04422 111 8122222 6600 08 a aE nnn 280 Creating a Regime Expressed in Single Strength 2 2000 283 Creating a Regime Expressed in Mixed Strength Tablets 286 Setting the Max Step Betw een 00 0 0 0 eene 288 Setting Defaults for New Instructioris nee cie 293 Creating Day UUCTIONS T 293 Creating a Day Pattern Instr
17. 199 DPE GUME TIL NOIES eL 199 Treatment Notes FEQIIIGQINCG otc 200 Dawn Version 7 E Manual 11 12 Part XXI 1 2 3 Part XXII 1 Part XXIII A c N Part XXIV Part XXV 5 0096 c 200 AUUIOrIse MeSSdaUBS PEE E PE 201 Producing Messages Manually From DAWN 203 MILL MCI ME A 203 Letters Tab Dose Not Authorised 22 1 204 POD Up Warning Mesage eua E Eu 204 Test Date Changes for a Warfarin or other Vitamin K antagonist Patient 206 Select a New Date and Time from the 207 Handling Non Attendance for a Warfarin or other Vitamin K antagonist Patient 209 eei NR LEID 210 Patient uds cies ane cuneo cosas e pde e xcd Pe eio stunde aUa Ds SU IRA OPE dne 210 Show Ine DNA i teca dudo cu OUR E 211 Using List Views Reschedule Anticoagulation Patients 212 Managing Patients Under Different Therapies 214 DOSING set Umm 214 Standard Induction Algorithms Included in 22
18. Dawn Version 7 E Manual Dawn AC Version 7 Manual The followng manual wil go through some of the steps needed to use Dawn AC inlcuding adding and dosing patients wthin the system Please call our support team on 015395 63091 if you have any user queries Dawn Version 7 E Manual 2014 All rights reserved No parts of this work may be reproduced in any form or by any means graphic electronic or mechanical including photocopying recording taping or information storage and retrieval systems without the written permission of the publisher Products that are referred to in this document may be either trademarks and or registered trademarks of the respective owners The publisher and the author make no claim to these trademarks While every precaution has been taken in the preparation of this document the publisher and the author assume no responsibility for errors or omissions or for damages resulting from the use of information contained in this document or from the use of programs and source code that may accompany it In no event shall the publisher and the author be liable for any loss of profit or any other commercial damage caused or alleged to have been caused directly or indirectly by this document Printed February 2014 4 Dawn Version 7 E Manual Table of Contents Part I Part Il 1 Part Ill Part IV Part V Part Part VII Part VIII 1 2 3 Part IX 1 2 3 4 5 6 7 Forewo
19. Give relative percentage Lap adj Res Cap adj Sun Mon Tue Wed Thu Fri Sal 2014 Settings for DAWN AC 9 11 7 Saved Clinic Adjustment Form Clinic ApplicationArea Organisation Description Anticoagulation 45 Dawn Clinical Software Anticoagulation Clinic x gt anticoagulation Big Hospital Moorside Clinic x ApplicationArea Anticoagulation Description Moorside Clinic Organisation Click here to create the diary Localt ade InUse a ndare stantie Re holiday 314082008 TTE a 2014 90 Dawn Version 7 E Manual 9 11 8 Creating the Diary Clinic ApplicationArealOrganisation Description CTS Anticoagulation 45 Dawn Clinical Software Anticoagulation Clinic Be Anticoagulation Big Hospital Moorside Clinic ApplicationArea Anticoagulation Description Moorside Clinic Organisation Bia Hospital E i a I Week with appointmen Week about to be delen 4 Last day in diary diary available of weeks to create of weeks to delete 2014 Settings for DAWN AC 9 11 9 Clinic Diary Slots Clinic ApplicationArea Organisation Description Anticoagulation 45 Dawn Clinical Software Anticoagulation Clinic Anticoagulation
20. Home phone Mobile phone work phone 7 twmmbe Email address Messaging method pone selected v lt Previous step Cancel 2014 Adding a New Anticoagulation Patient 179 18 1 4 Wizard Screen Clinical Details New Patient Wizard Additional diagnoses Allergies There are no items to displa Risks Blood group None selected High risk O Weight 1 kg Measuredat 88 Height m Measuedat BSA EEUU 18 1 5 Wizard Screen Contact Details fe mpm Detai tep 4 Clin E Step 5 Contact Details b Referring GP 11 DETHICK COURT BISS TF Consultant 15 DEBADALE HOUSE BAKER K LI Team members here are no items to display 2014 1 Dawn Version 7 E Manual 18 1 6 New Patient Screen Stevens Nina 01 01 1966 1355433 1 burnt houses high road workington Risk class Pref clinic Bank Postal Clinic BANK AFICARDIOVERSION 2 0 3 0 2 5 Target arfarin 1 Daily Dose 2551 20097 Indefinite 4 1 b ofi active Ups Status Scheduled Next EL SSS UL Graph History Personal Treatmentplans Ad Questionnaires Test Results Interface Warnings Time linrange Comments Wed 25 11 2008 0 0 0 00 df Add history data 18 1 6 1 Adding History CREER NGA ge as ree a
21. Sun Thu sun Wed ee ee Ju Sun Wed UE 21 007 80mg 12 Using 12h dosing the PM dose is automatically set to the same value as the AM dose 13 If the dose is automatically populated with the default dose defined for the LMWH drug the full amount is displayed for the for both the AM and PM For example if the dose defined for the LMWH drug is 40 mg and you select 12h single amount the patient s dose defaults to AM dose 40 and PM dose 40 14 The PM dose is read only 15 If the default Dose defined as a Dose per kg rather than an absolute amount DAWN works out the dose from the patient s weight and displays the result 2014 242 Dawn Version 7 E Manual Dosing contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y fate rained BL a x Sat Sun Tue Wed Fi Sun Wed Sun Tue Wed Thu 08 0063 503mg 14 The patient s weight and the date it was measured are displayed beneath the instruction 15 If you record the patient s weight in lb DAWN AC automatically converts the patient s weight to kg to perform the Dose per kg calculation It displays the weight kg and lbs as a reference 16 If the patient s weight has not been recorded in DAWN no dose is calculated and a warning is
22. 2 57431 2014 Dawn Version 7 E Manual 14 2 Test Result Monitor Screen Test Result Monitor Selection Errored Ignored Processed New Show all Sorting Sample Wo Status Name Search 920152 Errored 11 12 2008 11 55 WERT D3 00 7 523456 Final 11 12 2008 12 00 10 12 2008 03 00 28 527654 Final 2014 16 Dawn Version 7 E Manual 15 Data Exchange Data exchange allows users to easily import and export items such as Dosing Regimes Message Templates List Views Custom Modules and Look up tables to and from their DAWN system without needing to involve the IT department For example the support team may create a new list view and email it to you as an XML file You would save the file to your local machine and import it into DAWN using the Data Exchange import facility The new list view would then be installed and ready for testing iu Fou arae currently togged an Support 45 user proie Tap Grace Frontpage Normal Tables Lookup tables D AW N 7 Reports Management ae E53 Clinic View settings i MessageManagement E3 Printing Reports doe A Parameter edit dose a patien Report List view Daily routines Attendance and nan attendance Polar Reporting B Audit amp security DawnInterface lli system Y Diary
23. 2 222 191 Ser Date TO AME 192 Accept Ine DOSING InstrUellOni esu 192 Amending the Dosing nnn 193 Dose DECREASE eec 193 5 Sn ntn 194 Ware oi P o T pte Pr 194 Patient Switched to Manual Bridging 195 Switching Patient Back to Maintenance 195 Further Amending the Dose lt 196 Hcr Eee E 196 SKID Days Or BOOST DayS 1 n noe te Enc rre 197 DOSE c 198 Set No DOSE TTE 198 Amending the Next Test Date 2222 200202 022 172 22 2
24. Patient view Ca ak Add edit or dose a patient List view Daily routines Attendance and non attendance Consult the diary Message center Menage messages ang Reports Luztam repa rts Settings 7 Modify your personal settings Current location Far printing Select a location M Moof Active Patients B Patients on Treatment Mow Missed Test Needs rescheduling Mo next test date 2 Needs scheduling 9 10 1 Personal Settings Form Personal settings HiddenPatientTabSheets Letters Drugs Events Procedures Reviews Reminders Groups Documents Graph History NextofKin Clinical Owners Audit TreatmentPlans InitialPatient TabSheet None selected wv InitialVisitHistoryDisplay Make a choice SuppresSentMessagesNotifications SuppresTreatmentWarnings LocalSettings_PatientHeight None selected LocalSettings PatientWeight None selected EnableCustomizedWeekPatterns 2014 Dawn Version 7 E Manual 9 11 Adding a New Clinic Clinics must be set up within the system so that patients can be booked into these clinics for each visit Patients can also be logged as having a particular preferred clinic You will need to set up an Organisation before creating a new clinic LicenseAgreement License MaxActivePatientiaunt Frontpage
25. Coumadin say Coumadin Pantoven say SY usa __ JiWarfain Sy Taro usa Warfarin HUSA Generic Warfarin MP finthrome fBinthrome pindevan S Pheninidione generic Phenindene M Previscan Marcoumar piumam 2 M Pindione 2 Create a record for each anticoagulant brand you wish to use These can be generic for a region such as UK warfarin or identify individual brands available in a particular region such as Coumadin Jantoven and warfarin in the USA Use the display name to record the brand name as you wish it to appear on a dosing instruction 3 You can associate a dosing regime with a particular brand so you could have a Coumadin a Jantoven and warfarin dosing regime for the same tablet strength As these regimes are all for the same Anticoagulant record warfarin you can swap between them at any stage in a patient s treatment 272 Dawn Version 7 E Manual 4 lf you associate a regime with a particular brand the formatted dosing instructions show the brand display name If no brand is associated with a regime the anticoagulant name is displayed on formatted dosing instruction 25 4 1 2 1 Creating an AC Brand 1 Choose Lookup Tables ACBrand from the System Menu to display the ACBrand lookup table and choose the orange New button at the foot of the form The new AC brand record is displayed ACbra
26. Hospital Moorside Clinic ApplicationArea Anticoagulation Description Organisation Big Hospital Localtode 71 m InUse 1 Create Delete Diary 2009 25 2009 27 2009 28 2009 29 2009 30 2009 31 2009 32 2009 33 21 06 2009 25 06 2009 05 07 2009 12 07 2009 19 07 2009 26 07 2009 02 08 2009 09 08 2009 480 240 480 240 480 240 480 240 480 240 480 240 48D 240 480 240 2009 27 week with appointments 2009 29 week about to be deletd Your new cli ry UT ES Remove data from diary 9 12 Risk Settings There are 3 steps involved in configuring the Risk and Risk Class Set Severity for Risk Set Risk Set Risk Class 2014 Dawn Version 7 E Manual 9 License MaxActivePatientCour You are currently logged on az Support 45 with user profile Top Grade Frontpage Normal Tables Anticoagulation Tables e Alleray A Anticoac lat BloodGroup Diagnosis Drug 7 Patient view Q pruginceracdon Jak Add edit or dose a patient EthnicOrigin Event List view Daily routines HCProfessionalType Attendance and non attendance JournalltemType LetterTemplate iog Diary OrganisationType Consult the diary Procedure Risk Message center Severity j Manage messages and pass messages by phone SeverityType Risk
27. M 89 Creating the Daly costae ieee S 90 ensis E 91 91 Severity or FISK SCING 92 1 MEN te 93 RISK M 94 13 Adding Edir ng 95 97 Adding a New Patient Al r Gy e 98 14 Eding BIGOG 98 LAST OF IBIOOG eb cct 100 Adding a Blood iet 101 15 Adding Editing DrIagriO Ses nen 101 List Of DIAGNOSES EERETEDET oe mcot 103 Adding a New DIAGNOSIS c S 104 16 Adding Ediling DIUG S siseseid erno ae a aara r ENA 104 ES t 106 New DRUG cR
28. score Sc New Oral Anticoagulants non VKA Section Active clinically significant bleeding 387 Hepatic impairment or liver disease expected to have any impact on survival Hypersensitivity to dabigatran etexilate Hypersensitivity to sunset yellow E110 Organic lesion at risk of bleeding severe renal impairment crCL 30ml min Active ulcerative Gl disease Bacterialendocarditis Brain spinal or ophthalmic surgery Congenital or aquired coagulation disorder Recent biopsy or major trauma Recent gastrointestinal bleeding Recent ICH Thrombocytopenia or functional platelet defects Congestive heart failure or left ventricular systolic dysfunction Hypertension blood pressure consistently above 140 90 mmHe or treated hypertension on medication Age 275 years Diabetes Mellitus Prior Stroke or TIA or thromboembolism Vascular disease e g peripheral artery disease myocardial infarction aortic plaque Age 65 74 years Sex category i e female gender 2014 388 27 1 4 Dawn Version 7 E Manual HASBLED score Hypertension E systolic blood pressure 160 mmHg or uncontrolled 1 Renal Disease 1 A gt 200uM or 2 6mg dL Liver Disease crrhosis bilirubin22xUL N gt 1 5 Stroke History 1 B Prior Major Bleeding or Predisposition to Bleeding 1 L JLabile 1 E 265 years 1 Medication Usage Predisposing to Bleeding 1 D A
29. 04 08 2012 7 E Stopped at 06 09 2012 Or e changing the reason for anticoagulation Treatment plans for Trouble Trevor 01 01 1932 Disease area PrimaryDiagnosis Start date Duration in weeks status ORTHO HIP Total hip replacement surgery 13 08 2012 06 08 2012 12 New Anticoagulation AFNR Atrial fibrillation nonvalvular 30 08 2012 30 08 2012 stopped For changes such as a change to clinic or duration of treatment click on Treatment plan to edit and save your changes i Any changes to the treatment plan will be audited in the Audit tab on the Treatment Plan screen like this PrimaryDiagnosts ORTHO HIP Total hip replacer Start date 56 09 2012 Firstseendate Duration type Short Term Target ram Duration Weeks Days Regime Induction Preferred clinic Postal Clinic 5t Elsewhere Sample ins Preferred time From uud MaxPercen CessationReason selected MaxlInterv Status ProblemPa LITTLE U aU This treatment plan ChangeDate Time FieldName FromYalue 05 08 2012 14 01 fkiPreferredCliniclD Default Clinic St Elsewhere Postal Clinic 05 08 2012 14 01 iDurationlnWeeks 12 14 2014 44 Dawn Version 7 E Manual 27 2 2 3 back to Detailed Workflow page Stopping a non VKA treatment plan For any significant change to a patient s anticoagulation such as changing drug or res
30. Mon Tue Wed Thu Fri Sat 20 15 Total mic 1 1 1 eee in this Regime the smallest tablet strength is 1 mg and the smallest permitted tablet part is half a tablet giving a smallest permitted unit of 1 mg However in this instruction the doses for Sun and Wed differ by 1mg If any instruction fails this check the following message is displayed Windows Internet Explorer AN Error updating Instruction with average dose of 1 50 The gap between the highest and the lowest day is mare than half of the smallest tablet Solution Update the instruction so that the warfarin dosage is distributed more evenly between the days and no two days differ by more than the smallest permitted unit For example the above instruction should be rewritten as follows Sun Mon Tue Wed Thu Sat 1 5 1 5 1 5 1 5 15 15 1 5 Please note this does directly affect the size the increments between different instructions as you can step up by one mg per day or quarter of a mg per week without falling foul of this rule It simply ensures that the dose is distributed as evenly as possible through the week 2014 Anticoagulants Dosing Regimes and Instructions warfarin 321 As such if you use half tablets it would force you to have say two doses of 2 mg and five doses of 2mg rather than one dose of 3mg and six of 5mg It also guards against mistyping e g 25 instead of 2 5 Please als
31. VBScript Confirm stable dose p Switching to maintenance therapy activates automatic maintenance dose calculation For this patient To switch to maintenance therapy you must eJ confirm Ehat the patient is on a stable maintenance dose Date of referral Referring GP Can you confirm this patient is on a stable maintenance dose 45 Dawn Clinical Software Consultant woodside surgery Stanley ReferralNotes 2014 1 Dawn Version 7 E Manual 20 9 Further Amending the Dose Instruction 54657565 1801 Parani Rd babait Sun Mon Tue wed Thu Fri Sat ills 10 mg 10 ERI Total m 10 5 10 5 dose decreased bv 1095 Dose Ww atus Tested Next Ina roo Accept dose Date HR 10712009 37 45 00 Click here to zee an exar iE le when the ycle button iz clicked 26 06 2009 24 50 00 voy Y Fri 15 05 2008 2 6 20 00 ve da B wk 4 a 14 04 2009 2 6 21 00 Wed 09 04 2009 2 1 21 00 ve 1 07 04 2009 2 7 21 00 ve ii LAT 20 9 4 Tablet Shifts m m Tue Wed ER m m Ing iz 7 2014 Dosing a Warfarin or other Vitamin antagonist Patient 20 9 2 Skip Days or Boost Days 1801 LZ Rd 22 Date 01 07 2009 3 x3 Not scheduled Sun o Wed m e e m Pay NES
32. WARFARIN 10 MG WEEKLY DOSE Oz 372008 Treatment stopped lt i gt 01 stopped 2 1 Next Screen Patient Diagnoses Diagnoses Stevenson Lisa 01 01 1922 DiagnosisDate DiagnosisNotes Recorded by Dia gt 3 ARRHYTHMIA SUPRAVENTRICULAR 5410412009 D Big Hospital Support 45 2 iy ANGINA 20 04 2009 V 2 port 45 2 04 We are taken to this next screen 2014 18 Dawn Version 7 E Manual 3 Getting Started Workflow WORKING THROUGH THE SYSTEM Before starting to dose patients and use the DAWN system in a live situation we need to set up several sections first This configures the DAWN system to your specific needs so that patients can be monitored quickly and effectively and all the information logged against them is correct e g the patient is booked into the correct clinic at the correct time and has the correct referring GP and consultant details The following flowchart shows the steps typically required to get started with the system 2014 Getting Started Workflow o 2014 Safety Section 1 4 Safety Section Introduction This document is intended to highlight potential safety issues that must be understood and addressed before using the DAWN Clinical Framework Anticoagulation module It is vital for the on going safe operation of your software that users of the software are aware of the Safety Instruc
33. Lookup Tables What are They List of LOOKUP Coded Comments Viewing Unmatched Interface Results Hold Monitor 2 111 66 6 rua Test Result Monitor 22 Data Exchange ivre mee Et eee mm Setting up Printing User Guide Setting up a Print cbe rx pu Cedo ou ep aa Setting Up DawnMailer to process Messages for a Print Station Setting up a new Paper TVDQ coi cuu Uove cosskR DRE UDRO EC c cpOE RR Une DURO DA UGG Oo A Part XVII Part XVIII 1 Part XIX 10 2014 Contents Mapping Printers with PrinterPaperType eere eee eee ee eee 163 Setting Up a New Printing 0 164 Selecting Paper in Message eene nnn 167 Selecting Paper Type in Message 168 Logging In Active Directory Support 171 Adding a New Anticoagulation Patient 175 Choosing New Patient ee RUN 176 New Patient Wizard SCl a8 Ti cse ates ir
34. Phone x Ma warnings Age the tient BYPASS GRAFT 2 0 3 0 2 0103 2009 Patient is not attending 4 1 of 1 NonAttending Ose ef Treatment Plan Status New Auto Schedule Dose Time LOC ve 1 id ve 1 2 wk 1 1 Big Hospital Support 45 another note to try 2014 Handling Non Attendance for a Warfarin or other Vitamin antagonist Patient 23 3 2014 Show the DNA Count Scheduled For Wed 01 07 2009 09 00 17 00 in clinic Anticoagulation Clinic Reschedule manually Date Mo warnings H dos 0 Status Scheduled 9 eH Accept INR f Un schedule enting SN NEIN LT forcing 0107 2009 0 00 w E Y Thu 1106 2009 2 1 20 00 ve da Tue 1404 2009 2 3 70 00 w 1 Tue OF 04 2009 2B 70 00 w 1 212 Dawn Version 7 E Manual 23 4 Using List Views To Reschedule Anticoagulation Patients f Non Attendance a Y 1 xis IHRDate DHACount ET NEUES All patients bul All risk classes i 3457567 Henley Jason 01 07 2009 D 2344 Pye Delia 01 0 2009 5 Anticoagulation All CAll clinics Any date All types 2 rales v All teams Days to advance 2014 214 Daw
35. ReferenceRange Testaroup Therapy Template Trial DrugTemplate Questionnaire Type Message center Manage messages and pass messages by phone GeneralLookupCategory Reports Team Custom reports Lookup tables Reports Settings 2014 wo Dawn Version 7 E Manual 10 1 Clinic Diary Screen Clinic Diary date eu pe 06 2009 ze Sun 21 06 2009 22 06 2009 Tue 23 06 2009 Wed24 06 2009 Thu 25 06 2009 Fri 26 06 2009 Sat 27 06 2009 100 41095 1001010 100 10 100 10 99 10 99110 100 10 09 00 17 00 S Stevenson Lisa 01740171922 54657565 1801 Pa 2014 142 Dawn Version 7 E Manual 11 List Views What are They List Views are lists of patient records selected and ordered on predefined criteria Use List Views to quickly access records for patients attending today patients with abnormal INR results reminders outstanding Up to 10 List Views can be configured in your DAWN system The user can apply filters such as date range or patient status to refine the list of records viewed Bulk messages can be sent for patients identified on a List View If you edit amend list views within the system remember to check all changes thoroughly This can be done using a dummy patient within the system Click HERE to look at how to view a list view 11 1 Accessing List Views From the Frontpage menu choose List View LicenseAgreem
36. clinical Haematology Rheumatology 122 Anticoagulation clinical Haematology Rheumatology dF anticoagulation no Dawn Version 7 E Manual 9 17 2 Adding a New Event Event New record event nam e can be added Description WarnLevel DurationOfW arning Relevant for m ccn Rm o rpm m Omer to Wee 9 18 Adding Editing Procedures If you need to add a procedure that does not exist in the standard list new procedures can be added here 2014 Settings for DAWN 111 LicenseAgreement Welcome License MaxActivePatientCaunt Fou are currently fogged an Sunpart 45 wt wrer profile Top Grade Frontpage 2 Normal Tables are S Lookup tables Anticoagulation Tables RAMEWOR allera BloodGroup Diagnosis Patient view ey amp Cruginteraction e EthnicOrigin Event HCProfessionalTvpe amp JournalltemType LetterTemplate OorganisationType Procedure Anticoagulati Add edit ar dose a patient List view Daily routines Attendance and non attendance Diary Consult the diary Risk Message center Severity Manage Messages and pass messages by phone Severity Type RiskClass Reports Custom reports Spplication4rea e Diagnosisaroup DiagnosisStage Discipline
37. eode Linus adimi ses 423 424 Other anticoagulant or platelet 000 00000000000 00 424 Other contraindication CERDO D o 425 IAC MORN AGICSFIS KS 426 CHA DS and HASBLED SCOE S sect 427 FAQ non VKA records on DAWN 0 428 Changing 430 Chahging between differe nt 6 430 Changing c 430 Changing between and non VKA oiii iio 431 Bridging Anticoagulation with LMWH 431 Viewing Patient EN SLORY RUE 432 Handling Non Attendance for non VKA 1 433 Non attendance 5 u iiie echo boa YR RR ac deo EC De a OR Bo 434 RUNNING stieg ET 434 Settings for New Oral
38. 196 2 04 2 00 LowerLimit UpperLimit Avg dose Luz In part instr luce Pd In part instr Pd part instr nes o 0 jInpart instr DayPattern 2 Enter up to four lines of text 3 The Avg or total Dose is not calculated automatically for non daypattern instructions and 2014 Anticoagulants Dosing Regimes and Instructions warfarin 299 must be entered manually The upper and lower limits are calculated automatically in the same way as Day Pattern instructions See the following sections for more details Creating DayPattern Instructions Creating a DayPattern Instruction in mg Creating a Dosing Regime Setting the Max Step Between Instructions 4 You are prevented from saving a non daypattern instruction unless there is an entry in all three of these fields 5 When you attempt to activate a Regime DAWN AC performs checks to ensure all instructions in the regime are valid complete and contain no duplicates DAWN AC does not allow you to activate a regime if any of the following discrepancies are found e One or more Instructions have the Same Avg or Total Dose e The Regime contains Missing Instructions e Selected Tablets do not match the Selected Brand 25 4 2 4 Cloning a Dosing Regime You may wish to create a new regime based on an existing one For example you may have a regime that shows doses in 3mg tablets for a particular brand such as Taro warfarin and you want to the sam
39. 2 0 3 0 2 5 Target 1511 20137 Indefinite Warfarin Same Dose Daily 1 3 amp 5mg Tablets ofi active 2 Click the Stop button 2014 Stopping Treatment Deactivating or Marking a Patient as Deceased Indefinite Preferred clinic default Hosp Preferred time From until Status active suspend E DAWN displays a message box asking you to confirm you wish to stop the Treatment Plan The message box contains an optional free text notes field 3 If you wish to enter a note explaining why treatment was stopped type your note in the notes field 4 Press OK to confirm you wish to stop the Treatment Plan The Treatment Plan status changes to Stopped If the patient has no other treatment plan active in another disease area Such as Haematology or DVT assessment DAWN displays a message box reminding you to deactivate the patient See the next section for instructions on deactivating patients Message from webpage You may need to deactivate this patient record to allow other patients to be monitored on DAWN remember to choose the Personal tab and adjust the patient status 19 2 Deactivating and Reactivating a patient DAWN is licensed in part on the number of active patients When a patient stops treatment and is not about to start a new course of treatment deactivate their patient record to free up a patient license Inactive patient are still available to view
40. 610 374 3522 home gt of 1 active days then d Thu Fri Amending the Next Test Date 54657565 1801 Paremill Rd Bransty Reading 20 00 w 21 00 w 21 00 w 21 00 wif 21 00 w 01 01 1922 54657565 1801 Paremill Rd Bransty Reading Dosing a Warfarin or other Vitamin K antagonist Patient Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Date 01 07 2009 v gt Not scheduled j Tablets for days then Warfarin Sun Tue WwW 5 0 0 INR 2 6 InRange Total 5 10 M No dose change Dose W Status Tested Next 08 07 2009 Accept dose Graph History Personal Treatment plans Wed 01 07 2008 Fri 26 06 2009 Fri 15 05 2009 Tue 14 04 2009 Wed 08 04 2009 Tue 07 04 2009 Mon 06 04 2009 Graph Y Y z Warnings next interval found Check stability last two doses differ by 150 Treatment notes gp Missed tablets for last two days EE 1 356 Show all 200 Dawn Version 7 E Manual 20 10 1 Treatment Notes Highlighted Time DNA linrange comments rd B wk B wk 4 Co LIIS LI 20 11 Authorise Dose 1801 Paremi ll Rd Bransty Reading Y INR 2 6 InRange Date 01 07 2009 v j Tablets Far days then Warfarin Sun Mon Tue Wed Thu Fri Sak Total m 5 10 5 10 5 10 Wo dose change stat
41. To view a page you have already opened previously you can choose the screen you require from the tabs list at the left of the screen 2014 How To Navigate Around DAWN o semen Patient List view Organisation Reports Report Active Patient Counts by Clinic v Show report Download as Download as Text EE To bring up an additional menu on the DAWN front screen choose the F5 key on your keyboard or click on the Sys Menu button at the top left of the screen License MaxAct on the Frontpage Normal Tables HealthAuthariby e Organisation e Ward HCProFessianal Clinic Patientcroup LoginLoq Clinic diary Lm e Meeting MeetingTemplate Jest ReferenceRange e Testaroup Therapy Template Trial DrugqTemplate Questionnairel ype ii Senerall To close all open screens and go back to the original DAWN front screen from anywhere within the system click on the Close All Tabs button at the top left of the screen 2014 4 Dawn Version 7 E Manual License tvePatientCount Frontpage Normal Tables Healthauthority Organisation ward HCProfessional Clinic Patienttsroup LoginLog Clinic diary Meeting Meeting Template Test ReferenceRange e JestGroup Therapy Template e Trial DrugTemplate Que
42. has been set to ahncku The user will need to immediately set a new password when First logging in LE b a Je ete 1S Adding Teams Different teams can be set up within the system so that healthcare professionals can belong to a particular team within DAWN e g Anticoagulation Nurses Rheumatology Nurses Healthcare professionals can belong to more than one team at a time List views can be used to filter patients by particular teams Dawn Version 7 E Manual LicenseAgreement Welcome License MaxActivePatienti aunt Fou are currently fogged on ar Support 35 awh usar Top Grade Frontpage 5 Normal Tables a HealthAutharit E D AW N LINI Y amp Organisation Wel CREE TS F RAN SR Cf Ward Anticoai HC Professional 1 Clinic Patientiroup Patient view add edit ar dose a patient Clinic diary List view Daily routines MeetingTemplate attendance and non attendance e Test ReferenceR ange e Testroup Consult the diary Therapy Template Trial Message center DrugTemplate Manage messages and pass messages by pl Questionnairel ype Ee Click here to add Reports Team Custam reports Lookup tables 1 Reports Settings Management a Modify your personal settings 2014 Settings for DAWN AC 9 9 1 Team Form Team There a
43. 0 2 453 Patient Identifiers in Screen 454 Restricting Who Can Change NHS the Number 455 Variance Growth Rate VGR 458 What is Variance Growth Rate 22 2 458 Index 464 11 12 Foreword 2014 mM Dawn Version 7 E Manual 1 Company Name and Address DAWN CLINICAL SOFTWARE DAWN is registered trademark of 4S Information Systems Ltd and represents a new era in software where the adaptability built into the software empowers the customers with minimum IT professional help to quickly get the information they require from their system without long delays 4S DAWN Clinical Software Telephone 44 0 15395 63091 Facsimile 44 0 15395 62475 4 The Square Milnthorpe Cumbria LA7 7QJ UK E mail sales 4s DAWN com Website http www 4s DAWN com 2014 16 Dawn Version 7 E Manual 2 How To Use the Manual HOW TO USE THE MANUAL If a text bubble asks you to Click Here and a red circle is present on the bubble you will be able to click on the link to take you to the next screen For example clicking on the link on the image below will take you to another screen Stevenson Lisa 01 01 1922 54657562 Risk class Pref clinic Anticoagulation Clinic 12345 Phone 610 374 3522 home Age
44. 07 04 2009 2 3 21 00 vv di 5 Hover the mouse over the information icon to display both the actual dosing instruction the patient took and the instruction they were supposed to take 25 3 10 Preventing dose calculations based on inappropriate doses Summary of criteria for preventing dosing calculation based on a previous dose Automatic dose calculation is prevented where the last treatment record meets any of the 2014 252 Dawn Version 7 E Manual following criteria 1 Therapy Bridging 2 Custom Instruction Spans 7 days unless the current Therapy is Induction 3 Custom Instruction includes a LMWH dose 4 Custom Instruction comprises a major edit that is it includes one or more days with doses that differ from each other by more than the minimum unit as defined in the regime The minimum unit is the minimum tablet part of the smallest tablet size in other words the smallest tablet size half the smallest tablet size or quarter of the smallest tablet size in the regime depending on MinimumTabletPart setting see Creating a Dosing Regime INR 2 3 InRange Date 30 07 2009 Y w5 Not scheduled NO DOSE COULD BE CALCULATED Calc prevented Previous Instruction did not span days Dose manually Treatment notes Status Tested Accept dose Tommen Y Thu 30 07 2008 0 0
45. 2014 366 Dawn Version 7 E Manual 26 2 ERROR regime is currenthy mot Active It cannot be used ERROR The regime amp currently nor Active It cannot be used ERROR The regime currenth mot Active cannot be used 111 111 i PILLS 3 MG SIZE PER DAY PILLS 3 M SIZE DAY Cun Pon Tue Wei Thay oos Change 1 GUT OF 1 ABOVE 3 3 next interval Found HM Dose deceased 10 Dose 4 07 d Status DoseAuthorised Next 14 10 2009 7 d BANK ROAD HEALTH CENTRE Pearson Lucy Miscellaneous 5tatus history Audt ACTherapy Maintenance Nonattendancecount SeeDrElag SeenDrFlag O Sample No ContactStatus MoRenurement AutoAuthorisationh esult Close out of the treatments screen by clicking on the black cross to the top right of the page You will now be on the patient screen and will be able to re enter the INR and or dose for the patient Rescheduling a Patient s Next Appointment When DAWN books a patient into a next appointment date it puts the patient into the first available slot within the diary To change the patient s next appointment date or time once a dose has been authorised you can click on the Reschedule Manually button on their Dosing tab 2014 2014 Frequently Asked Anticoagulation Questions 367 Dosing Treatment notes M dose zero Status Scheduled A cli
46. Dose LMWHdefaultFrequency Mane selected RA Motes 2 Enter a name for the Regime This name is displayed in the selection list of regimes for this drug so it must accurately describe the dose and frequency e g Manual 3 Name is a required field You are prohibited from saving the record without a name 4 Select the ManualRegime checkbox The Dose and Default Frequency options are hidden 2014 Anticoagulants Dosing Regimes and Instructions warfarin 339 you do not predefine values for these in a manual regime instead these options are presented for the user to select each time they set the LMWH dose for a patient 5 oelect the Weight Based check box to define upper or lower limits in units per kg for example 0 5 mg per kg and 1 7 mg per kg the units e g mg or iu are defined for the LMWH drug as a whole Deselect the Weight Based check box to define a fixed upper and lower dose limit for example 30 and 150 mg 6 Enter an appropriate Upper Limit Lower Limit and Dose for this Regime If you have selected the Weight Based checkbox the doses you specify here are doses per kg When defining these limits allow sufficient headroom for rounding the dose to the nearest pre filled syringe size if appropriate For example if a patient weighs 70 kg and the dose is 1mg per kg the patient s theoretical dose is 7Omg However if the nearest pre filled syringe size is 80 mg it is necessary to prescrib
47. Procedure List view Daily routines Attendance and nan attendance consult the diary e Risk Message center Severity Manage messages and pass messages by phone Severity Type e RiskClass ea Reports Custom repo rts Diagnosiziroup DiagnosisStage Discipline MeetingTvpe m m Settings pplication rea Modify your personal settings 2014 Settings for DAWN AC 109 9 17 1 List of Events Event DurationOfWarning event Relevant for 2014 5 15 UNSPECIFIED Hol BEEN UNWELL Always warn i3 BLEED LOWER GI G cep uprer Gr LY BRUISING UNEXPLAINED always warn xo5l 05 CEREBRAL HAEMORRHAGE Always warn a gt Always warn warn re an the Mew EXTRA ALCOHCH Always wp 2 En cw Dore N vr aine f Anticoagulation Clinical Haematology A list al Rheumatology J Anticoagulation clinical Haematology Rheumatology nticosguitation clinical Haematology Rheumatology Anticoagulation clinical Haematology Rheumatology oF anticoagulation clinical Haematology Rheumatology 2 anticoagulation Clinical Haematology Rheumatology L Anticoagulation clinical Haematology Rheumatology D O n Anticoagulation
48. ShowInstructionTotalDoseLine Tablet 1 Pills 6 mg Blue Green 5 Tablet 2 7 5g Fills 735 mg Yellow US Gener T Tablet 3 Pills 10 mg White USA 10 Instruction record 1 50 70 Total dose 4 5 3 00 si 6 00 10 5 9 00 12 00 15 5 15 00 des 16 00 22 5 21 00 He 24 00 25 5 28 5 2T 00 MaxiInstructionDoseIncrement 3 Defaults for new instructions DayPattern O pica instr instr 3 22 in part instr Tablets selected in right order 4 Once you have selected the tablets press Save DAWN AC updates all the instructions for the regime If the smallest tablet size has changed the upper and lower limits and average or total dose is recalculated for each instruction using the new tablet size for the top line LowerLimit 10 5 UpperLimil las Total dose 12 00 1 Sun Hon Tue Wed Thu Fri Sat In part instr Linez 4 D 4 4 In part instr IX Line3 Teal tablet z 6 mg strength In part instr Line4 In part instr DayPattern X i Sun Man Tue Wed Thu Fri Sak EICHENSEER 3 0 3 0 3 0 3 Original instruction for a dose 2014 Anticoagulants Dosing Regimes and Instructions warfarin 305 LowerLimit 10 5 UpperLimit 13 5 Total dose 17 00 Line 1 Sun Mon Tue Wed Thu Fri Sat In part instr Line 14
49. 2014 338 Dawn Version 7 E Manual 1 14mg per kg Establish the actual dose per kg represented by your largest likely dose rounding and set the Max dose and Min doses accordingly e g 0 8 and 1 2 mg per kg 7 Select the default frequency If the drug is administered every 12 hours choose One dose 12 hours If the drug is administered every 24 hours choose One dose 24 hours If the drug is administered every 24 hours but this regime is frequently used for bridging and you generally prescribe a half dose on the day before the patient s procedure choose Once per 24 hours two dose sizes In this case DAWN sets the alternative dose to half the full dose Please note if you intend to use the 24 hours two dose sizes option to specify a half dose on a particular day for certain patients ensure your lower limit is small enough to accomodate the lowest likely dose 8 Enter any notes about this regime and its uses These are only visible in this form or in reports and Message Templates Upper and Lower dose limits apply to the dose for each injection not the cumulative dose for 24 hours 25 5 2 2 Creating a manual LMWH drug regime 1 Click the new record icon beside the LMWHDrugRegime list to add a new LMWHDrugRegime The new LMWH drug regime form appears LMWHdrugRegime Enoxaparin New record Name ManualRegime WeightBased LowerLimit UpperLimit Ii
50. 239 Dosing contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y EET Mon Mon Wed Thu MEN 73 Sun Wed Sun Mon Toe Wed T 08 00 2 5mg LMWH Fondaperinux S 24h amount Dose 1 934 Y Status Tested Next Graph History Personal Treatment plans Ad Hoc Questionnaires Date INR Dose i Comments Mon 19 11 2007 17 FA Contacted Patient Called and discussed meds Sun 08 07 2007 Sun 27 05 2007 Sun 18 03 2007 Sun 04 02 2007 Sun 07 01 2007 Sun 17 12 2006 Sun 05 11 2006 Sun 24 09 2006 Sun 27 08 2006 Sun 06 08 2006 Sun 23 07 2006 Sun 02 07 2006 Tue 13 06 2006 Tue 06 06 2006 m em je 3 If the LMWH drug has syringe sizes defined the dose field comprises a drop down list of available syringe sizes To modify the dose select an alternative dose from the available syringe sizes INR 1 7 Low Y Date 19 11 2007 Y HR Tena re rg Sat Sun Tue Wed Thu Sat Sun Mon Tue Wed Thu Fis Sun Mon Tue Wed TES Sat Sun x Wed eer Dose 1 93d Y Status Tested Net l 4 If no LMWH Drug regimes are defined for the drug the default dose frequency is 24h 2014 240 Dawn Version 7 E Manual single amount As a consequence the default ins
51. 56 Adding a New Organisation Ward nnn 56 EISt OF WARS oie e E OTA E A ne 58 New Ward FOr P8 59 Adding a New Patient Group 59 ET tol Paent GrOUDS ee ctm 61 New Patient Group Form ee P R S 62 Adding a Egli m 62 Viewing and Editing Existing User Profiles croceo eaae aa ea anon rase uasa 64 Adding a New User Profle 2 quoad sd SR 65 Adding Editing Healthcare Professional 22 68 Contents 5 List of Healthcare Professional Types 69 Adding a New Healthcare Professional 70 8 Adding a New Healthcare 1 70 List of Healthcare 72 Adding Healthcare Professional Details eese eene eene nennen nn
52. AllowViewPatientTelAppFields 1 AllowEditPatientTelAppFields AllowedPatientTabSheets Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Graph History NextOrkin Clinical TreatmentPland X I XI XI X I XI XI X lt XI I xl xl Questionnaires PatientResults 2014 Settings for DAWN AC 6 9 6 2 Adding a New User Profile LserProfile Description Top Grade Middle Grade Lower Grade Patients Interface Description AllowCreatePatient x AllowEditPatientData x E E AllowChangeRiskClass AllowEditPatientOrganisations AllowDeactivatePatient a AllowViewPatientTelAppFields allowEditPatientTelAppFields AllowedPatientTabSheets contacts v Letters w Drugs Events v Procedures w Reviews v Reminders Groups Documents v Graph v History v Clinical v Owners v it TreatmentPlans a I I I I I I XI XI I XI I lt I 2014 Dawn Version 7 E Manual AllowAdyancedPatientTabSheets AllowDeletePatient Treatment plan Allow reateTreatmentPlan AllowEditTreatmentPlanTestLimits Allow Activate AndEditTreatmentPlan AllowSuspendStopTreatmentPlan AllowAdmitDischargeTreatmentPlan AllowDeleteTreatmentPlan AllowEditPatientTherapyPhase
53. Brain spinal or ophthalmic surgery Congenital or aquired coagulation disorder Recent biopsy or major trauma Recent gastrointestinal bleeding Recent ICH The list of haemorrhagic risks be edited added to by your system administrator using the Look Up Tables called Risks and Specific Risks NB any risks identified on the Initiation Questionnaire will NOT automatically display at the top left of your patient screen see adding Risks for a new patient section or click on Risks button to add risks on the patient screen Risk dass High Pref dinic None selected Phone hame Atrial fibrillation nonvalvular Hon VKA 05 09 20127 Dabigatran 150 mg twice daily New back to Initiation Questionnaire page back to FAQs page back to Risk Settings page 27 2 1 2 11 Dabigatran Dose The dose recorded on the Initiation Questionnaire may be chosen from any regime for this anticoagulant on DAWN AC 2014 408 Dawn Version 7 E Manual Dabigatran Dose None selected Valid dosing regimes for this indication are Dosing regime Advice Dabigatran 150 mg twice daily Normal dose Dabigatran 110 mg twice daily Patients aged 80 or over or at risk of bleeding This screen shows advice for permitted regimes set for the chosen Therapeutic Indication at the top of this questionnaire To update or change the displayed options request that your system administra
54. DAWN AC prevents automatic dose calculation for the next INR 2014 Anticoagulants Dosing Regimes and Instructions warfarin 233 25 3 3 Change the First Day of the Week INR 2 6 InRange i i CS E m B Set Mon Tue wed Thu Sat Suri e 2 21 2 1 1 n Tue na 4 dose change Dose 50 00 w Status Tested Next 12 05 2009 3 wk Accept dose RN Time Tin Wed 22 07 72008 50 00 w 1 3 wk Wed 08 07 2018 21 S000 wa EA 2 wk 010702009 26 soowg Missed tablets for last two days 000 Y Fri 26 06 2009 24 5000 waa 1 Tue 14 04 2009 2 5 21 00 w el Wied 08 04 2009 2 1 21 00 vv il Tue OF 040008 2 7 21 00 vv g Mon 04 2009 2 1 21 00 vv el Fri 15 05 2008 2 6 20 00 w 1 B wk 4 LL LI 2014 234 Dawn Version 7 E Manual Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 12 10 2007 Y v e M Sun Tue Wed Thu Warfarin Fri t Sun Tue Wed Thu ST abs img v v i V Va aS Total m y Di5 5A 5A oY SY 5 4 Dose increased by 22 Dose 38 50 w Y Status Tested Next 19 10 2007 7d Graph History Personal Treatment plans Ad Hoc Questionnaires Date INK Dose Time DNA In range C
55. Dawn Version 7 E Manual Choosing New Patient Form 3 L Selection Active patients Patients with active Treatment Plans For selected app area Shaw all Search far Last name First name Unito Town O County Postcode Dateofbirth Dob M Language E CS Mobile phone Work phone DS of kin Mob phone Last namne rirse mane Age UNO into arch Postcod EE Summers Abigail 74 9998 hire L49 Eel i0JenTest JenTest win iijentest JenTest Jwii i2JenTest JenTest Jw12 i3JenTest JenTest t4JenTest JenTest 74714 E amp amp y i5JenTest JenTest 7415 163enTest JenTest ifJentest JenTest JW17 183enTest JenTest 7418 19JenTest JenTest 74719 Eg amp 1JenTest JenTest 44 TWiz3Jen JenNationale 21 07 1965 1 Lab Cottages IMgleton via Carnforth Lancs Sey 20JenTest Jentest Jw20 Eg 5 2 jentest 2jentest jenunit2 jennate SJentest Jentest 3123 4Jentest Jentest 241234 Eg 5j JenTest JenTest 1412345 546246 45643 34543 567356 3567653765 34543 amp Jenkest Jentest 14123455 uM gt gt 5 gt 5 gt EA Down New 0 Save Details M 2014 Adding a New Anticoagulation Patient 177 18 1 1 New Patient Wizard Screen New Patient Wizard New record
56. ERROR The regime is currently not Active It cannot be used warning is displayed in place of the instruction d Settings for Regimes n Maintenance and their instructions can be altered 4 Deactivated Not In Use a Deactivated Regimes do not appear in the Regime selection list on the Treatment plan form b Patients may already be on a regime when it is Deactivated this case the instructions cannot be used while the Regime is Deactivated C If you attempt to dose a patient on a Deactivated Regime ERROR The regime is currently not Active It cannot be used warning is displayed in place of the instruction d Settings for Deactivated Regimes and their instructions can be altered 25 4 2 7 2 Activating a Regime To activate a new in maintenance or deactivated regime 1 Choose Lookup Tables Anticoagulation Tables Regime from the System menu to display the list of existing dosing regimes 2 Select the Regime you wish to activate from the list and press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License 2014 Anticoagulants Dosing Regimes and Instructions warfarin 311 agreement and Customer Obligations document Windows Internet Explorer T wWwARNIMG You are ab
57. a i WEIT nude JE consult the diary Message center International settings E Manage messages and pass messages bw phon DataExchange CustomModule Reports Custom rts CodedComment Settings Modifv Your personal settings 2014 Data Exchange 15 1 Export Screen Polar DataExchangeg Export E us he Table En export 4cbrand w Fite O OE Mot selected For export Selected For export Generic t WarFarin Coumadin 54 Coumadin Jantoven LI5A Janbtaven Barr U54 Warfarin Tara USA warFarin USA Generic Warfarin Sinthrome Sinthrorne Dindewvan Dindevan Pheninidione generic Phenindiane Previscan Previscan Marcoumar Marcournar Dicumaral Dicumaral Pindione Pindione Sintrom Sintram Marevan Download selected data 2014 158 Dawn Version 7 E Manual 15 2 Import Screen Browse 2014 16 Dawn Version 7 E Manual 16 Setting up Printing User Guide If you wish to print from DAWN manually from a patient record no setting up is required DAWN will simply use your internet explorer page settings You may wish to remove the header footer and margins as required DAWN AC allows you to automate the generation of messages in response to certain events such as authorising a dose scheduling a test or rescheduling a non attender For example you might con
58. ctiori Iri rire 295 Creating a Day Pattern Instruction in Single Strength 08 00 297 Creating a Day Pattern Instruction in Mixed Strength 448880 297 Creating Non DayPattern plain text 298 Cloning a Dos ibd uo Duo s ea Lu LA Dr ae cant 299 Changing or Inserting Additional Tablet Strengths into a 301 Displaying Instructions In Fractions or 307 Activating Deactivating and Maintaining reQimes cccccccceeecceceaeeeeeeeeeeeeeeeeeeeeeeeaeaaaaedeeeeeeeeeeeeeeeaeaaaaaneeeees 309 Regine Work FOW Sales dade er t eto E Mun pedea EIU EH 309 Acivaing a ses vb Puer te sva a adie 310 cop PE 312 No tw o Instructions have the Same Avg or Total 4004400 313 WESSING M 313 betw een the Highest and Low est Day is too 0 0 319 Selected Tablets match the Selected 321 Maintaming a RE
59. ris iam 10 vl Wed 0810422009 2 1 27 00 we 1 Total mg Tue OF 042009 2 7 21 00 vv Mon 06 04 2009 2 1 21 00 w io gt 1 In previous versions of DAWN version 7 xx the dosing instruction was displayed the patient s treatment history However formatted Dosing Instructions may include up to 3 tablet strengths a total mg line and 2 lines of LMWH dosing instruction see Add an LMWH instruction To accomodate this additional width and height the dosing instruction has been removed from the patient s treatment history and replaced with an information icon Hovering the mouse over the information icon displays the complete dosing instruction together with any LMWH instruction and the complete treatment notes for the selected treatment record 2 If a Treatment record includes a LMWH dosing instruction a syringe icon is displayed beside the information icon 3 If a Treatment record includes a customised instruction a pencil and form icon is displayed beside the information and LMWH icon A green icon indicates a minor change where the pattern has been altered but the doses for no two differ by more than the minimum tablet part of the smallest tablet strength used in the regime A red icon indicates a major 2014 Anticoagulants Dosing Regimes and Instructions warfarin 251 change where the doses for two or more days differ by more than the minimum tablet part of the smallest tablet strength use
60. you must perform the steps described in the section Working with Dosing Instructions Permitting or Prohibiting Custom Instructions to permit some or all users to customise indvidual instructions for patients Scenarios The following scenarios aim to put certain aspects of the design in context by showing how they would be used to achieve specific tasks or solve specific problems Scenario Bridging Therapy The following scenario illustrates how an anticoagulation nurse Maggie Marshall might edit a dosing instruction for a patient on Bridging therapy with a procedure on Wednesday The example is not based on any actual bridging protocol but it hopefully illustrates how a bridging protocol could be used The example uses British tablet colours Clexane is a brand name for Enoxaparin used in the UK Maggie has switched the patient s therapy to Bridging so when she enters an INR DAWN AC does not automatically calculate a dose IMR 2 8InRange 09 07 2009 Y Not scheduled m Even when dosing sci Therapy Dose manually EEROR No dosing instructions found instruction is Found wou can double click here to enter a custom instruction nates Status Tested 8 Maggie could type a dose in the dose field but this would give a standard instruction showing a dose for each day of the week Maggie wants to stop warfarin until after the patient s procedure then restart with a higher loading do
61. 0 Needs rescheduling Mo next test date 2 Needs scheduling Ma INR today 0 0 Awaiting rezult yet ta attend dose today 0 0 Needs Dose Instruction 2014 How To Navigate Around DAWN 8 3 Dawn search option Paien OO OOOO O Le Selection Active patients Patients with active Treatment Plans Fofir Search for Last name Town Dateotbirth Home phone Mobile phone Next of kin name 122 Next of kin Mab phone Last name First name Age UnitNo National No Dateofbirth Address 1 Addr gt Mouse Minnie 95123654 Summers Abigail 74 9998 19 01 1935 23 North Hill Close 2014 9 1 9 1 1 2014 Settings for DAWN AC Settings for DAWN AC Adding a Health Authority Health Authorities can be added into the system in order to group organisations for reporting purposes A health authority needs to be added before an organisation can be created Sikh gerent gi Welcome License MaxActivePatientCour You are currently logged on Support 45 with user profile Top Grade Frontpage CNormal Tables HealthAuthority D AW N Organisation Ward Anticoagulatic HCProfessional Clinic PatientGroup 7 Patient view Q LoginLog Bo Add edit or dose a patient Clinic diary eng List view Daily routines MeetingTemplate Attendance and non attendance Test ReferenceRange to Diary TestGroup F Consult th
62. 1 17 1 2 0 1 4 nn nnn 216 221 Manual Bridging DOSING ies 223 Anticoagulants Dosing Regimes and Instructions warfarin 226 Dosing Regimes Basic 226 DOSING Instruciion Type Si t RR 227 Working with Dosing ona 228 Day Pattern Instructions formatted sse essa 229 Customising Dosing Instructions recourir nao a eora ree c ckx epu aano aa s28 53D es Cea cra nnmnnn 230 Cha nge the First Day ofthe Week creto 925233 cubare a kx a Lex ak 233 Leave Days Out of the Instruction ere niic eoe ina en nay apap 235 InstrucHons In MO gU aE 237 Adding LMWH eigo eio o re 237 Validation LMWH dOS ES osae aaa a
63. 1 1 Creating a Regime Expressed in Mg 1 Follow the instructions in the preceding section Creating a Dosing Regime to create a new regime and set the general settings 2 Choose mg from the drop down list of DoseUnits options to create a regime expressed in mg 2014 Anticoagulants Dosing Regimes and Instructions warfarin 2014 Regime New record Description Status Anticoagulant DailyWeekly BDoseUnits Tablet White UK Warfarin Tablet img Brown UK Warfarin Instruction Tablet 3mg Blue UK Warfarin au will need bo save this new record brTablet Sma Pink Warfarin step between instructions MaxInstructionDoseIncrement Defaults for new instructions DayPattern p Lineidefault Cd part instr Line2default Cd in part instr inser Clone Regime 4 3 Click the drop down list of of tablet strengths to view the options If you have selected brand the list of tablets includes only tablets for this brand If you have not selected a brand tablets marked as In Use for all brands are displayed It is advisable to mark tablets for brands that you do not use as Not In Use so they are not available for selection 4 Choose the smallest tablet strength you use from the drop down list of Tablets For example if you use mixed tablets and the smallest strength you give to a pa
64. 168 0 lbs Measured 27 11 2007 2014 356 Dawn Version 7 E Manual Maggie leaves the default injection times of 08 00 and 20 00 as these are appropriate for her patient She ticks the check boxes for the mornings and afternoons on which she wishes the patient to take an injection she specifies injections twice a day apart from the day before the procedure when she wants the patient to miss the afternoon dose and the day of the procedure where she wants the patient to miss the morning dose Maggie closes the Customise dosing instruction form and the patient s instruction and numeric dose are updated with her changes The change results in a 3596 dose decrease which exceeds the max usually permitted for the patient s treatment plan Consequently a red question mark is displayed beside the dose When Maggie hovers over the question mark a pop up message explains why it has been raised ERES m p WW mw T e INR 2 8 InRange Date 09 07 2009 Y gt Mat scheduled Sun Mon Tue Wed Thu Fri Sak Warnings 21 1 Calc prevented Bridging Therapy Dose manually 1 1 0 0 1 5 F Fri Pure ep Warning You entered a dose that gives dase change Status Tested that is larger than allowed For this treatment plan allowed change is 20 the dose changed 35 From 4 07 to 2 64 Please correct the Dose or click the to Accept dose accept Ehe cur
65. 21 If syringe sizes have been defined for the LMWH drug the patient s dose is automatically rounded to the nearest syringe size Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y x Sat Wed Thu Pills 1mg ille Sma Sat Sun Mon Wed Thu MEN 0 7v 6 Suni Tue Wed Thu Sun Mon Wed Dose 1 93 d ng n Patient s weight 58 1 kg 128 0 lbs Measured 20 11 2007 Calculated dose 58 1 Mg Day Status Tested 22 Hover your mouse over the patient s weight to see the unrounded calculated dose 23 If LMWH drug regimes have been defined for the drug to allow the use of different fixed or weight based dosing protocols select the appropriate regime from a drop down list of 2014 Anticoagulants Dosing Regimes and Instructions warfarin 245 options Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y _ Sat Sun Mon Wed Thu Fri Sat Sun Tue Wed Thu 2 0 0 Sun Mon Tue Wed Thu BALLS gt sun 30M g a 21 007 30Mg 2 rd s Dose 1 930 Y Status Tested Next wi alind pem zT 5125 1 5 mg The dose an
66. 3 0 00 10 00 0 1 4 1 4 1 9 0 00 5 00 0 1 4 2 0 2 9 0 00 2 50 0 1 4 3 0 3 5 0 00 1 00 1 4 3 6 5 0 0 00 0 00 1 1 5 0 0 1 3 0 00 10 00 0 1 5 1 4 1 9 0 00 7 50 0 1 5 2 0 2 9 0 00 5 00 0 1 5 3 0 3 5 0 00 2 50 0 1 5 3 6 5 0 0 00 0 00 1 1 6 0 0 1 3 0 00 10 00 0 1 6 1 4 1 9 0 00 7 50 0 1 6 2 0 2 9 0 00 5 00 0 1 6 3 0 929 0 00 2 50 0 1 6 3 6 5 0 0 00 0 00 1 1 7 0 0 1 3 0 00 10 00 0 1 7 1 4 1 9 0 00 7 50 0 1 7 2 0 2 9 0 00 5 00 0 1 7 3 0 35 0 00 2 00 0 1 7 3 6 5 0 0 00 0 00 1 1 3 Fennerty Et Al Sex Dose by Day in Both 4 mg per day INR Between Last Dose Dose Miss Days Interval Day 1 0 0 1 4 0 00 10 00 0 1 2 0 0 1 7 0 00 10 00 0 1 2 1 8 1 8 0 00 1 00 0 1 2 1 9 5 0 0 00 0 50 0 1 3 0 0 1 9 0 00 10 00 0 1 3 2 0 2 1 0 00 5 00 0 1 3 2 2 2 3 0 00 4 50 0 1 2014 Managing Patients Under Different Therapies 219 3 2 4 2 5 0 00 4 00 0 1 3 2 6 2 7 0 00 3 50 0 1 3 2 8 2 9 0 00 3 00 0 1 3 3 0 3 1 0 00 2 50 0 1 3 3 2 3 9 0 00 2 00 0 1 3 3 4 3 4 0 00 150 00 1 3 3 5 3 5 0 00 1 00 0 1 3 3 6 4 0 0 00 0 50 0 1 3 4 0 5 0 0 00 0 00 1 1 4 1 4 1 4 0 00 8 00 0 1 4 1 5 1 5 0 00 7 590 0 1 4 1 6 D 0 00 00 0 1 4 1 8 1 8 0 00 6 50 0 1 4 1 9 1 9 0 00 6 00 0 1 4 2 0 2 1 0 00 9 90 0 1 4 2 2 2 3 0 00 9 00 0 1 4 2 4 2 6 0 00 450 0 1 4 2 7 3 0 0 00 4 00 0 1 4 3 1 3 5 0 00 3 50 0 1 4 3 6 4 0 0 00 3 00 0 1 4 4 1 4 5 0 00 2 00 1 1 4 4 5 5 0 0 00 1 00 2 1 4 Oates Et Al Female Sex Dose by D
67. 3 83 Y Fri 19062009 24 21 00 w di 2 yk 3 patient feeling dizzy Mon 18 5 2008 2 4 21 00 di B wk 14 04 2008 2 4 21 00 ve di 07 04 2009 2 5 21 00 vv di _ Wed 10 06 2009 2 1 21 00 di wk 1 CRITICAL CASE LEFT MESSAGE 4 Hover your mouse over the information icon of the record to display both the Actual dosing instruction the patient took and the intended dosing instruction they were supposed to take 5 Once a subsequent dose has been calculated you can no longer adjust a previous dose to reflect the actual dose the patient took as this dose has already been used in the subsequent dose calculation In this case double clicking the last instruction has no effect You would have to reset the subsequent treatment record adjust the last dose then re enter the subsequent INR 25 3 12 Induction Dosing As Induction dosing algorithms frequently specify tests at intervals of less than one week Induction users in previous versions have often used a simple Induction dosing regime for Induction dosing Such regimes are plain text non daypattern and show just the suggested daily dose for example 5 mg or 4 mg 2014 256 Dawn Version 7 E Manual INR 1 0 Low Y Date 30 11 2007 v Not scheduled No warnings Treatment notes arm M no previous dose Dose 00 9 Status Tested 04 12 2007 EE 4 d Graph History Personal Treatment plans Ad Hoc Questionna
68. 6 Displaying Instructions In Fractions or Decimals By default all dosing instructions display doses that include halves or quarters as fractions for example 212 tablets 34 mg Sun Mon Tue This behaviour can be altered by amending one of two system settings e AC DisplayDosinglnstructions ShowTotalMglnDecimals e AC DisplayDosinglnstructions InDecimals If you wish to have all doses display decimal places rather than fractions e g 2 5 tablets 3 25 mg change the value of the DisplayDosinglnstructionsInDecimals system setting to 1 on Customizations Mame Ve Description DisplayDosingInstructions ShowTotalMgInDecimals b Should the Total Mg line of a dosing instruction always be displayed in decimals regardless of whether the tablet lines are shown in fractions 0 No 1 Yes DisplayDosingInstructionsInDecimals Must the AC dosing instructions be displayed using fractions 0 or AC DisplayTextStyleDosingInstructions Must the AC dosing instructions be displayed in text style 1 instead of HTML formatted style 0 All doses in an instruction whether expressed in mg tablets or tablets with a Total mg line as shown below now show in decimals Sun Mon Tue Wed Thu 2014 Dawn Version 7 E Manual lt The AC DisplayDosinglnstructionsInDecimals system setting does not apply to the older style plain text instructions that are generated for backwards compatibility when the AC Display Te
69. Anticoagulant Monitoring s Service Newcastle Upon Tyne Tyne amp Wear 11 YTG Tel 01539563091 Mr Hedley STEPHENSON Hosp No H672563 57 Woodman Cottages 042 245 Colliery Row NHS 012 345 6789 Towbank Date of Birth 01 07 1942 Co Durham NR56 8HJ Treatment Plan Anticoagulant Warfarin Diagnosis ATRIAL FIBRILLATION Target INR Range 2 0 3 0 2 5 Target Start Date 07 07 2006 Duration Indefinite If mandatory NHS number compliance is not in force or Validate and Verify Only compliance is in force the number is never suppressed in letters faxes and electronic output whatever its status See also Overview Switching on NHS Number Compliance 2014 452 Dawn Version 7 E Manual 28 4 Changes to the New Patient Wizard when you Enforce Compliance When you switch on either level of mandatory NHS number compliance DAWN makes small changes to the patient screen X a Last name Morecambe v Ethnic origin None selected x First name Derek B Primary language None selected se Home phone Cd Mobile phone Date of birth Work phone Fax number NHS Email address Messaging method Mail NHS status L Risk class High T nu will need to save this new record before you can add related ecords Town County Post Code Notes e The national number is a
70. Bridging INRs The maintenance therapy option in DAWN is intended for dosing patients who are already on or close to a stable maintenance dose Doses added as history while on maintenance therapy are assumed to be maintenance doses DAWN provides two other therapy options for patients who are not on a stable maintenance dose These are Induction and Bridging Where a patient s warfarin is stopped or reduced for a surgical procedure there are three options for recording INRs Stopping the current treatment plan and starting a new plan DAWN disables automatic maintenance dose calculation for the first six days following the treatment plan start date which forces the healthcare professional to manually set the dose and the next test interval 2014 370 Or Dawn Version 7 E Manual e Using the Induction module designed specifically for reinitiating a patient Or e Switching to using the bridging therapy option within the Maintenance module which disables automatic dose and interval calculation for all subsequent INRs until a healthcare professional deliberately switches the patient back to maintenance therapy To either create a new treatment plan and use induction therapy or switch the current treatment plan therapy to bridging you need to amend the therapy field within the patient s treatment plan Screen PrimaryDiagnosis B Anticoagulation ATRIAL FIBRILLATION 0211 2009 24 02 2005 500 D
71. CICLOSPORIN MRACONAZOLE KETOCONAZOLE TACROLIMUS The list of drugs displayed are defined in the Look Up Tables on your DAWN AC database and additional drugs may be added to this list as required Please contact your system administrator to add new drug settings to the Interacting Drugs table 2014 4 Dawn Version 7 E Manual back to Complete a Follow up page 2 2 3 2 7 Interacting drugs some interacting drugs may be known to be increase the haemorrhagic risk if used along with the chosen anticoagulant See relevant published prescribing guidelines Please tick any drugs if your patient is currently prescribed this drug Interacting Drugs AMIODARONE ASPIRIN CLARITHROMYCIN CLOPIDOGREL DICLOFENAC IBUPROFEN KETOPROFEN NAPROSYN QUINIDINE VERAPAMIL selecting one or more listed drugs will cause some advice to be displayed on screen like this Interacting Drugs AMIODARONE CLOPIDOGREL 77 ASPIRIN Close clinical su rveillance looking for signs of bleeding or anaemia CLARITHROMYCIN CLOPIDOGREL For prevention of VTEs after hip or knee DICLOFENAC surgery dosing should be reduced to IBUPROFEN 150mg per day taken once daily as 2 capsules of 75mg dabigatran etexilate m Close clinical surveillance particularly in NAPROSYN the occurrence of bleeding notably in 7 QUINIDINE patients having m VERAPAMIL The list of drugs displayed and the advice displayed on screen are defi
72. Dawn Version 7 E Manual 24 1 1 regime and target range if needed before pressing the Transfer button to move them over to maintenance therapy For example in changing the dosing regime to meet the varying dose requirements of your Induction protocol you might use more than one tablet strength during Induction therapy When you transfer the patient to maintenance therapy you may wish to move the patient on to a regime for the most appropriate single tablet strength Another consideration might be that most Induction protocols are expressed in daily doses If you normally record a total weekly dose for patients on maintenance therapy you may have a special daily dosing regime that you use for Induction If so you may wish to switch the patient on to one of your normal weekly regimes when you transfer them to maintenance therapy Please note in this case you should NOT change the dose to a total weekly amount as DAWN automatically converts the next dose to a weekly amount if the last dose is daily and the current regime is weekly If you decide that the patient should not be moved over to maintenance or vice versa yet then choose the Cancel button If you choose to Cancel the transfer to maintenance screen above then you can change the patient over to maintenance therapy later within their treatment plan IMPORTANT NOTE If you cancel from the Transfer to Maintenance screen and keep the patient on Induction therap
73. Enter The Total mg line is updated automatically 4 The Calculated Total mg line is always displayed in the Customise Dosing Instruction form for instructions expressed in tablets of more than 1mg strength regardless of the system regime setting that determines whether it is displayed in the finished instruction 5 On saving or hitting enter the total weekly dose or average daily dose in the main dosing panel on the left is updated with the new weekly total or daily average according to the regime setting of the customised pattern and the current instruction is updated with the changes to each day s dose 6 If the customised pattern causes the total weekly or average daily dose to cross any red question mark alert threshold such as large dose change direction of dose change 96 dose change treatment plan limit the red question mark alert is displayed in the same way as if the dose had been typed in to the numeric dose field or set using the up an down arrow buttons 7 Pressing the Close Edit form closes the Customise Dosing Instruction form and saves any changes 8 If you make a major edit to an instruction that is a customisation that changes the overall total weekly or average daily dose the numeric dose field and the up down last dose and 2014 232 Dawn Version 7 E Manual cycle buttons are all disabled The only way of changing the dose is now via the editing form 9 If you make a minor edit to an ins
74. Event HCProfessionalType JournalltemType LetterTemplate add edit or dose a patient List view Daily ro Attendance and nan attend Diary Organisation ype Consult the diary Procedure Risk Message center Severity Manage messages and pass Severity Type amp RiskClass Reports 4pplication4rea EROR reports Diagnosisaroup amp DiagnosisStage Settings e Modify your personal settii Meeting ype z DrogDoselnits DrugDurationUnits Current location For printing Select Drugmedium Category i Crug olumeUnits Moot Active Patients 1 Frequency Missed Test e warnLevel next test date VisitType E INF today 0 InterventionTimeslat Mo dose today E e essationReason Pending Messages Waiting 2014 Settings for DAWN ac 133 9 25 1 List of Cessation Reasons CessationReason Anticoagulation 5 advised Course Completed oY xi 3 8 Rheumatology erg reaction gt e 2014 134 Dawn Version 7 E Manual 9 25 2 Choosing Cessation Reason Application Area CessationReason New record Please select a Applicaktion amp rea Far the table LessationReason Anticoagulation Clinical Haematology Rheumatology ie r 2014 Settings for DAWN 135 9 2
75. Fall in the Next Week 2014 Maggie has a patient with a low INR on Friday She wants to instruct him to take 7 gt mg on Friday followed by 5mg on Saturday and Sunday but the Sunday dose carries forward into the following week and looks odd on the instruction as it appears to precede rather than succeed Dawn Version 7 E Manual the Friday and Saturday doses INR 2 6 InRange Sun Mon Tue Wed Thu Fri Sak es 1 1 NF E Dose 12 50 w Status Tested To correct this Maggie selects Friday as the first day of the week from the drop down list in the Customise Dosing Instruction form then enters appropriate doses under the appropriate days Sun Mon Tue Wed Thu INR 2 6 InRange Sat Sun Mon Tue Wed Thu LMWH drug Dose 17 50 w Status Tested Next 8 She also clicks the day name for Mon to deselect Monday As Tuesday Wednesday and Thursday follow Monday they are automatically deselected too Now it is clear the instruction only spans 3 days INR 2 6 InRange Sun LMWH drug Dose 5 83 d Status Tested Mext 88 O P As the instruction does not include all 7 days a Total Weekly dose is not calculated Instead 2014 Anticoagulants Dosing Regimes and Instructions warfarin 359 average daily dose is shown However where the instruction does not cover a full seven days it is likely as in this case to include e
76. HCProfessionalType Induction Algorithm JournalltemType ResultRange INR LetterTemplate ACTestAlias OrganisationType Qualifying Risk Factors Procedure NB deletion of an entry for Qualifying Risk Factors may cause loss of information in any patient questionnaire not completed or unlocked for editing back to Settings for New Oral Anticoagulants page Interacting drugs for non VKA Itis possible to link an anticoagulant with a drug which has one of the following interactions if prescribed concomitantly e Contraindication e Haemorrhagic Risk e hromboembolic Risk These settings have a notes field and the notes plus appropriate warnings will display on appropriate patient questionnaires and may prevent activation of a treatment plan See examples for contraindicated drugs and interacting drugs section 6 1 2 6 and section 6 1 2 5 2014 New Oral Anticoagulants non VKA Section 4 Interacting Drugs Anticoagulant Dabigatran Drug IBUPROFEN Interaction Haemorrhagicrisk Clinical Advice lose dinical surveillance looking for signs of EN NB addition editing deletion of entries on this table may cause checks on important drug interactions to be missed NB deletion of an entry for Interacting Drugs may cause loss of information in any patient questionnaire not completed or unlocked for editing back to Settings for New Oral Anticoagulant
77. Hegime If itis checked the new Instruction form displays a dose field for each day of the week These are laid out like a formatted instruction 2 If the Regime is in mg a single dose editable dose field is displayed for each day 3 he row caption says mg and no tablet image is displayed 4 If the DayPattern checkbox is selected Lines1 and 2 of the plain text instruction line are read only as these are filled in automatically from the doses you type in the fields for each day 5 You can type text in the Line3 and Line 4 fields but these are only used if the instruction is displayed in compatibility mode a plain text format which mimics the way daypattern instructions were displayed in previous versions of DAWN AC 6 If you uncheck the DayPattern checkbox all four text lines are editable but the indvidual dose fields for each day of the week are hidden Uncheck the DayPattern checkbox to define a purely textual dosing instruction see Creating Non DayPattern plain text Instructions 7 Ensure the DayPattern checkbox is checked to define a Daypattern instruction that can be displayed in the formatted style 2014 2 Dawn Version 7 E Manual Instruction Wartrin new regime New record Avg dose Linel In part instr once Hines PO part instr 3 nes 8 O DayPattern x Sun Mon Tue wed Thu Fri 8 Fill in the number of mg for each day and press Save The AvgDose or Tota
78. If Syringe sizes are defined for drug the LMWH dose field on the patient s instruction is displayed as list box and you can only select a valid option from the list 4 When you select a LMWH drug from the selection list on a patient s dosing instruction DAWN defaults the patient s dose to the absolute or per kg dose If syringe sizes are defined the dose is rounded to the nearest available syringe size For example if the dose specified here is 1 mg per kg and the drug is available in 60 or 80mg syringe a patent weighing 75kg gets a default dose of 80mg while a patient weighing 68 kg gets a default dose of 60 If the patient s dose falls exactly half way between two syringes sizes the dose is rounded up by default As such a patient weighing 70kg gets 80mg not 60 mg 2014 Anticoagulants Dosing Regimes and Instructions warfarin 333 25 5 1 1 Adding a Syringe Size Name DisplayName DoseUnits Dose per 1 Min dose Mg dose Mg Dose LMWHdrugSyringeSize ic HanuialRegime LS x i Manual 1 ma per kg once day 1 ma per Ka 12 ig 1 5 per once a day C 30 mg once a day 30 mg q12h 40 mg once a day 5 lt OrderNr Inlise 1 Click the new record icon beside the LMW HdrugSyringeSize list to add a new syringe size The LMWHDrugSyringSize New Record form is displayed 2 Enter the ne
79. Normal Tables Healthauthority ANN N CLINICA Organisation Welcome Fou are coment fogged an ar Support 45 wrer profile Tap Grace Ward HCProfessional Clinic Patientiroup Ankicos Patient view LoginLag add edit or dose a patient Clinic diary List view Daily routines MeetingTemplate attendance and non attendance Test ReferenceR ange Testaroup Therapy Template Trial DrugTemplate Questionnairelype Diary Consult the diary Message center Manage messages and pass messages by GeneralLaokupCategary Reports TERI Custom repo rts Lookup tables Reports da sac e ci Settings 2014 Settings for DAWN AC 9 11 1 List of Clinics Clinic Application Area Organisation Description Anticoagulation 45 Dawn Clinical Sottware Anticoagulation Clinic x ApplicationArea Anticoagulation Description hnticoagulation Clinic Organisation as Dawn Clinical Software jon M entry in th Localt ade InUse startTine endTine cap Reserved cap litera e 09 00 17 00 8 hours 2014 Dawn Version 7 E Manual 0 11 2 Adding Clinic Details Clinic New record ApplicationArea Description Organisation LocalCode InUse oum 2014 Settings for DAWN AC 9 11 3 A
80. Organic lesion at risk of bleeding I severe renal impairment crCL 30ml min Haemorrhagic Risks Active ulcerative GI disease Bacterialendocarditis Brain spinal or ophthalmic surgery Congenital or aquired coagulation disorder Recent biopsy or major trauma Hecent gastrointestinal bleeding Hecent ICH n E r Thrombocytopenia or functional platelet defects CHAJDS VASC score None selected C Congestive heart failure 1 orleft ventricular systolic dysfunction H Hypertension blood pressure consistently above 140 90 mmHg or 1 treated hypertension on medication gt 7 9 years 2 D Diabetes Mellitus 1 5 Prior Stroke or TIA or thromboembolism 2 Vascular disease e g peripheral artery disease myocardial 1 infarction aortic plaque 65 74 years 1 Sc Sex category i e female gender 1 2014 Dawn Version 7 E Manual HASBLED scare Procedures planned Who will follow your use of Dabigatran Age at due date Dabigatran Dose Status Scheduled Mark as complete Mane selected H Hypertension systolic blood pressure 160 mmHg or uncontrolled Renal Disease A gt 200uM or 2 6me dL Liver Disease cirrhosis bilirubin 2xULM AST ALT gt 5 Stroke History B Prior Major Bleeding or Predisposition to Bleeding L Labile IMR E gt 65 years Medication Usage Predispos
81. TextStyleDosingInstructions system setting and change the value from 1 to O 3 Press Save to save your change SystemSetting Sorting By Type Name Last changed Oy Customizations bius value Description FieldType AC DisplayTextStyleDosingInstructions t OE Must the AC dosing instructions be displayed in integer text style 1 instead of HTML Formatted style AC instructionStyleSheet The stylesheet For 4C instructions Text 0 0 In order for your HTML instructions to display in the correct format you have to unload and reload DAWN AC If your HTML instructions display like this SunMonTueWedThuFriSsat 2 2 22 2 2i o n El 111111 Pills 5 mg E otal mq T P P F FF as opposed to this Sun Mon Wed Thu Fri Sat Fi you need to unload and reload To unload and reload DAWN AC 4 If necessary follow the instructions in the Unloading and Reloading DAWN AC section to 2014 Anticoagulants Dosing Regimes and Instructions warfarin 353 unload and reload DAWN AC Day pattern dosing instructions now display in the formatted HTML style w Wwe ae Dosing INR 2 5 InRange Date 09 07 2009 Y Mot scheduled Warfarin Sun Mon Tue Wed Fri Sat Pils 10 mg WO tat 5 5 5 Total m 5 M Mo dose change Dose Status Tested Next
82. The ability to edit dosing instructions is not only useful for Bridging therapy In some cases you may need to change which doses are specified for which days for Maintenance patients as well In many cases the Cycle button is a more convenient way of doing this as you can move an odd dose to a different day of the week without the risk of inadvertently changing the total weekly or average daily dose 2014 360 Dawn Version 7 E Manual INR 2 5 InRange Date 20 07 2008 Y fo Warfarin Sun Mon Tue Wed Fri Sak 3 4 Total Maintenance Instruction default INR 2 5 InRange Date 20 07 2009 Y x Sun Mon Tue Wed Thu Fri Sak 3 oa pa a Maintenance Instruction after clicking Cycle button once However Maggie Marshall has just taken on a patient who until now attended a different clinic This patient has been used to taking mg on Saturday and Sunday and 477 mg during the week he pattern DAWN suggests for the same dose specifies the 3 mg doses on Monday and Friday This particular patient is stable and has got used to taking the odd doses at the weekend so she is reluctant to change this The cycle button is no use as it keeps the two odd doses 4 days apart whichever days they fall on Instead she edits the pattern and changes the first day of the week so Saturday and Sunday appear together then moves the odd doses to the weekend INR 2 5 InRa
83. The numeric dose in the dosing panel now displays a d or w to show whether it is a daily or weekly 2014 Anticoagulants Dosing Regimes and Instructions warfarin dose in the same way as doses displayed in the treatment history 6 DAWN AC prevents dose calculation where the previous dose instruction spanned less than 7 days 25 3 5 Instructions in Mg INR 2 8 InRange Date 22 07 2009 Y EIE REI nar Mon wed Thu Fri Sun Mon Tue wed Thu Fri Sat T LMWH drug Dose decreased by 0 Dose 7 14 d Status Tested Next 12 8 0 9 EE 3 wk Accept dose 1 If the dosing instructions is expressed in mg the formatted instructions comprise a single line The caption is mg and no tablet picture is included 2 Sometimes patients are given a single tablet strength but their dosing instructions are expressed in mg If the tablet strength is greater than 1mg some individual week day doses are not achievable For example you cannot take 2mg on Monday if you only have Strength tablets The Dosing Regime holds the minimum tablet strength and minimum part of a tablet that is permissible e g half a tablet quarter of a tablet whole tablet When customising a dosing instruction expressed in mg you are prevented from specifying a dose for any day that is not achievable using the smallest permissible part of the smallest possible tablet strength In other words if the
84. Version 7 E Manual 27 2 2 2 Primary diagnosis VALVE REP TISSUE DOUBLE VALVULAR HEART DISEASE UNSPEC VALVULAR REP MECHANICAL DOUBLE VALVULAR REPLACEMENT MECHANIC VALVULAR REPLACEMENT TISSUE VENTRICULAR SEP TAL DEFECT ORTHO HIP Total hip replacement surgery ORTHO KNEE Total knee replacement surgery e Target range must be non VKA for non vitamin antagonists e Regime choose the dose Regime None selected Mane selected Acenocoumaral Whole Tablets in Mg Daily Avg Dabigatran 150 mg once daily Dabigatran 150 mg twice daily Dabigatran 220 mg once daily Dabigatran 75 mg once daily lx 111 j e Duration type short term requires a duration long term has no duration The treatment plan may not be activated without these selections but if you do not have the details at hand you can save the treatment plan and activate it later back to Detailed Workflow page back to FAQs page Changing a non VKA treatment plan A ftis strongly recommended that you stop the treatment plan and start a new treatment plan for any significant change in the patient s anticoagulation section 4 2 3 and section 4 2 1 For example e changing dose from 220mg once daily to 150mg once daily 2014 New Oral Anticoagulants non VKA Section mM 06 09 2012T Indefinite Hon VKA Dabigatran 150mg once daily
85. Vitamin antagonist Patient 20 1 1 Calendar 1801 Paremill Rd Bransty Reading 2014 1 Dawn Version 7 E Manual 20 2 Detailed Treatment Screen O OF 146400928 21 00 O D 0804200921 21 00 O 0704 200927 21 00 O 0604 200921 21 00 INR 2 4 InRange Date 26 06 2009 Y gt Scheduled For Fri 26 06 2009 09 00 17 00 in clinic Anticoagulation Clinic Warfarin Sun Mon Tue Wed Thu Fri Sat Pils 0 mg 101 1 1 Total m S 10 5 io 5 i1 5 The treatment details lose increased by 150 Status Hasse DoseAuthorised Big Hospital Support 45 ACTherapy Maintenance SonAtbendanceCount SeeDrFlag SeenDrFlag Sample InPatient AutoAuthorisationR esull 2014 20 3 20 4 2014 Dosing a Warfarin or other Vitamin K antagonist Patient Entering INRs Significantly Different From Previous 54657565 1801 LLL Rd 4 Ji 7108 2009 09 00 14 00 ation Clinic Reschedule manually tdase zero Dose 0 00 w Microsoft Internet Explorer ng You entered an INR that is significantly different From the previous INR fcurrent INE i _ 2 5 Please correct the IMR or click the red to accept the current value m M1 Entering INR Date That is Not Today d Mere Ber
86. WARFARIN 1 Mi WEEKLY DOSE Clone Weekly In Maintenance E WARFARIN 10 MG WEEKLY DOSE weekly Active Warfarin Img Strength rin Ma Daily Sa Daily Warfarin Img Whole Tablets in Ma Daily Avg Daily T S DSE Weekly Motive 93 Description minbi TENE TaY deName WARIDW InUse Status ivt Maintain Anticoagulant Brand US4 Generic Warfarin Daily Weekly Weekly DoseUnits Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine Tablet 1 Pils 10 mg White USA Generic t 1 Instruction record 1 50 f 70 9 73 5 00 12 5 10 00 17 5 15 00 2265 20 00 27 5 25 Du oas 30 00 35 00 425 40 00 425 47 8 45 00 step between instructions 5 mg per Week MaxInstructionDoseIncrement 5 DayPattern Lineidefault In part instr Line default In part instr Line 3default In part instr Line4default In part instr 4 Press the Maintain button A pop up confirmation box appears Are you sure you want to perform the action Maintain on record Warfarin in Mg You can give a short explanation in the text field below optional 5 Enter any relevant notes in the explanation field this is optional These notes are stored in the workflow history of the regime so can be viewed in reports showing changes to the regime 6 Press the Cancel button to close the confirmation dialog without changing the regime status 7 Press the OK button to Maint
87. You may wish to record changes in your patient s anticoagulation on DAWN AC when Changing between different VKA s like Warfarin and phenindione section 7 1 Changing type of non VKA like Dabigatran to Rivaroxaban section 7 2 Changing between VKA and non VKA like Warfarin to Dabigatran or vice versa section 9 Bridging patients with LMWH section 7 4 back to Detailed Workflow page Changing between different VKA s In DAWN AC stop the treatment plan and start a new treatment plan for a change in the patient s anticoagulant Treatment plans for Stephenson Hedley 01 07 1932 gt Anticoagulation ATRIAL FIBRILLATION 11 04 10 03 2008 Disease area ACTherapy Induction PrimaryDiagnosis ATRIAL FIBRILLATION 11 04 v Maintenance Startdate rst seen date Fs C Duration type Long Term 2 0 3 0 2 5 Target First STOP emm Warfarin 2Vsmg Strength m None selected Preferred clinic treatment plan Preferred time Sun Mon Tue Wed Thu Fri CessationReason 1151161151 Pils 2 5 mg Status stopped MaxPercentDoseChange Note DAWN AC will prevent a change of anticoagulant within an active treatment plan back to Changing Anticoagulant page 27 3 2 Changing type of non VKA It is strongly recommended that you stop the treatment plan and start a new treatment plan for any significant change in the patien
88. a dose or next appointment back to Settings for New Oral Anticoagulants page Technical note the table name for Permitted Regimes is AnticoagulantlndicationRegime General Lookup Category settings for non VKA The general lookup category settings are used in some questionnaires Options available for answering questions on the questionnaire may be edited added to or deleted from this table 2 Dawn Version 7 E Manual LicenseAgreement GeneralLookupCategory License MaxActivePatientCour Frontpage Name CHA2D152 VASc Score Normal Tables Description CHA2DS2 VASc Score HealthAuthority m Organisation e Ward InUse HCProfessional GeneralLookup e Clic Caption Value PatientGroup i 0 0 LoginLog m Clinic diary 2 Meet F MeetingTemplate Ww 4 Test 5 TestAlias ReferenceRange 5 i Testiroup TherapyTemplate Trial DrugTemplate i Questi ireT See CHADS score section 6 1 2 12 NB renaming or deletion of an entry for General Lookup or General Lookup Category may cause loss of information in any patient questionnaire not completed or unlocked for editing back to Settings for New Oral Anticoagulants page 2014 aa Dawn Version 7 E Manual 28 28 1 Enforcing Mandatory Use of the NHS Number 1 Overview 2 Switching on NHS Number Compliance 3 Changes to the Patient Screen
89. all data entered via any of the tabs on the treatment plan screen has been entered and checked for correctness Attention should be paid to ensure the correct dosing regime has been selected i e the instruction of the tablets or pills to be taken by the patient the correct primary diagnosis has been entered for the patient the correct target INR range has been selected the correct start date has been entered if short term the correct treatment duration in weeks has been entered the correct maximum dose change and maximum test interval have been entered if a next test has been created the correct test date and preferred clinic has been entered and the visit has been correctly scheduled into the appropriate clinic diary Ensure the treatment plan has the correct status and has not been suspended or stopped in error The treatment plan should be activated before any dosing can be carried out Safety Check List for Adding Previous Treatment History You MUST check that the previous treatment history has been entered correctly Ensure the correct dosage results and INRs have been entered for this patient 2014 Safety Section 25 Note DAWN AC is designed for only one INR Dose record per day Be aware of the consequences of adding incomplete information missing doses and INRs entering zero values Safety Check List for Running Clinics Monitoring Patient Results Be aware with Maintenance Module
90. and Max dose limits apply to the dose for each injection not the cumulative dose for 24 hours If the LMWH drug is administered in different ways for different purposes for example 1 mg kg every 12 hours or a fixed dose of 30 mg every 24 hours depending on the patient s diagnosis you can set up different LMWH drug regimes See the following section Defining Different Dosing and Administration Regimes If you set up different regimes the min max and dose values you set for the drug as a whole act as default settings When you select the LMWH for a patient their dose defaults to the value specified here but can be overridden by selecting a regime from the drop down list of options See Working with Dosing Instructions Adding LMWH Instructions Leave the Min and Dose fields blank if you do not wish to define a default 25 5 1 Defining Syringe Sizes 1 If the drug is only available in certain pre filled syringe sizes add each syringe size to the LMW HdrugSyringeSize list 2014 332 Dawn Version 7 E Manual LA Hdrug Name DisplayName DoseUnits Dose per kg 1 Min dose 42 Mg dose Mg Dose Mg LIWHdrugSsyringeSize ic LMWHdrugRegime ML ML x E Manual e 1 mg per ka once day 1 ma per Ka 12 9 1 5 mg per Ky once day 30 once a day 30 mg 12 40 mg once a day OrderNr InUise x 5 2
91. colours depending on the risk of an event for a patient with a calculated value in that range By default three ranges are defined for each indicator with red indicating higher risk values amber average risk values and green the lowest risk category The VGR Setup screen is described in more detail in a later section of this chapter Patient Details Screen Changes Three new display only fields have been added to the Patient Details screen These fields are 6month Percentage Time in Range label Month label Maximum Difference label Max Diff Each of the TIR and VGR fields display a coloured box and a description The Max Diff field displays a number Calculation Details The and VGR values are calculated for a patient as described below when a new INR is recorded or deleted only manually entered history records can be deleted for the patient The VGR figures are only calculated and displayed for patients where the current Treatment Plan is Active status is Active or ActiveAdmitted and the current regime is a Vitamin anticoagulant The calculated values are compared with the ranges defined on the VGR Setup screen and the appropriate colour and description for each of the calculated values is then displayed on the Patient Details screen The actual calculated values and number of INRs used in each calculation can be seen by hovering over each of the coloured boxes 6 Month Percentage Ti
92. customise dosing instructions for individual patients lt also enables you to include Low Weight Molecular Heparin instructions The following sections describe how dosing regimes and instructions work in version 7 7 For non VKA dosing see section New Oral Anticoagulants For help adding new regimes for phenindione or other drugs please contact support 4s dawn com 25 2 Dosing Instruction Types DAWN AC supports two types of dosing instruction Daypatterns and Plain Text or non Daypattern instructions Daypattern instructions include a numeric dose for each day of the week They can be expressed in mg or in up to three different tablet strengths each on a different line with the option of displaying the Total mg at the bottom LIEL In part instr Mez tn part instr Lines In part instr x Line4 In part instr X Sun Man Tue Wed Thu Fri Sat Plain Text or non Daypattern instructions comprise up to four lines of text LowerLimilk 2525 UpperLimit 4 25 Total dose 3 50 Linel mq DAILY Lines Line4d DayPattern E 2014 2 Dawn Version 7 E Manual 25 3 Daypattern instructions for patients are displayed as formatted tables Sun Mon Tue Wed Thu Fri Sat zs e 21 2 2 2 l 1 1 1 1 1 1 Non day pattern instructions are as plain text Smg MON FRI mg SAT SUN Itis possible to have a Regime which consists of a mix of DayPattern and Plain Text i e non DayPat
93. definite Any significant change in the patient s anticoagulation management should be recorded by stopping the existing treatment plan and starting a new treatment plan NB DAWN AC will prevent a change of anticoagulant within an active treatment plan and require any existing treatment plan to be stopped DAWN AC provides INR and dosing screens for VKA like warfarin and questionnaires for non VKA management Each Questionnaire can be scheduled in advance and completed to store the important information for your patient Complete all sections and mark as complete See sections on changing treatment plan stopping a treatment plan starting a treatment plan for a new patient viewing patient history back to Detailed Workflow page 27 2 2 1 Starting a non VKA treatment plan The steps to starting a treatment plan for your patient on DAWN AC are outlined below as are the essential information you need for the treatment plan STEPS 2014 ao Dawn Version 7 E Manual 1 Add your patient to DAWN see how to add a patient record AND add an initiation questionnaire If your patient already has a record on DAWN AC ensure any other anticoagulation treatment plan is stopped and click on Treatment Plan and New to add a new treatment plan If your patient has no record on DAWN AC the New button on the Patient Search screen will take you to the following New Patient Wizard screen New Patient Wizard
94. each instruction This is easier to see if the Regime is a Weekly regime where the numeric dose is the Total Weekly rather than Average Daily dose Total Dose Lower Upper Limit Limit 75 so sso RN 8S DOR TEET N gt ih NM ms 826 _ B75 926 _ 975 _ 1075 However if the instruction with an average dose of 1 43 mg or total dose of 10 mg Is inadvertently missed out the instructions look like this D m om m LN LN a so oa a 2014 sie Dawn Version 7 E Manual Daily Regime Lower Upper Limit Limit ii li ahh Here the difference between the last 2 instructions is 1mg over the week rather than 1 2 mg over the week This leaves a gap between the upper limit of the instruction with an average dose of 1 36 mg or total dose of 9 5mg and the lower limit of instruction with an average dose of 1 5 mg or total dose of 10 5 mg Solution Simply create the missing instruction in this case Sun Tue Wed Thu Fri Sat 2014 Anticoagulants Dosing Regimes and Instructions warfarin The upper and lower limits and average or total doses of all the instructions are updated automatically and the gap disappears Cause 2 The Max Step Between Instructions settings are incorrect The Max Step settings determine how big the s
95. for follow up or not yet actively treated Initiation Questionnaire For anticoagulants such as Dabigatran you may wish to always complete an Initiation Questionnaire before activating a treatment plan on DAWN AC You can add a Dabigatran Initiation Questionnaire to any patient from the Questionnaires tab Dawn Version 7 E Manual Alderson Eddie 02 03 1947 D78137 Risk dass Low Pref None selected 111 222 4444 home 27 04 2012 t There is next appointment or active treatment to show Next appointment date E Create next appointn 12 ROCKCLIFFE GDNS WEST YORKS The Due Date will default to today but m are no items to display you can change this if you wish If you not ready to answer all the questions simply click OK and the details may be completed later The questions cover Indications and Risk Factors for Dabigatran therapy section 4 1 2 1 and section 4 1 2 2 Renal function including a calculator for Cockcroft Gault estimate of CrCl section 4 1 2 3 Records for hepatic impairment section 4 1 2 4 Contraindicated or Interacting drugs including other anticoagulants or platelet inhibitors section 4 1 2 5 and section 4 A reminder to ensure INR is not Contraindicated conditions and 4 1 2 10 Dabigatran dose section 4 1 2 11 1 2 6 2 or above if switching from a vitamin K antagonist
96. half dose 25 3 8 Miss and Boost Days with Multi Tablet Instructions INR 2 3 InRange Date 22 07 2009 w j 7 00 mg Far 1 days then Sun Mon Wed Sat 2 a za a 2 d od 1 7i z7 v7 rw 7 7 7 Customize dosing instruction Warfarin Mon Tue Wed Thu Fri Sat 71A i fora dose change Dose 50 00 w Status Tested Next 12 08 2009 3 wk 1 In previous releases the Miss or Boost rules took their units from the Regime If the Hegime was expressed in tablets the miss or boost instruction was expressed in tablets If the Regime was in mg the Miss or Boost rule was expressed in mg This functionality is preserved for Regimes in mg or single tablet strengths However if a regime comprises Mixed Tablets of more than one tablet strength miss or boost instructions are expressed in mg 2014 Anticoagulants Dosing Regimes and Instructions warfarin me 25 3 9 Dosing History days then M Sun Mon Tue Wed Thu Fri Sak warnings j 1 5 15 15 15 15 15 T 1 1 1 1 1 1 Treatment notes gp Patient has stopped taking tablets as advised currently trying to Find out what patient is actually taking Dose decreased by 23 Dose 38 50 w E Status Tested Next 2108 2009 3 wk Accept dose Graph History Personal Treatment plans ENENLILCNME ee in aras eani v Y Wed 22 07 2008 2 3 38 50 wa wk D has stopped t
97. misreading a decimal in the dosing instructions should be taken into account Losing Track of a Patient It is vital that a patient does not get lost within the system e g treatment plan wrongly closed no next test appointment made no follow up on non attendances Ensuring Operational Data and System Set up Integrity It is essential that the system and procedures are critically examined initially and routinely to ensure that the whole system integrity is maintained at all times Safety Check Lists Derived from identified safety considerations your procedures should incorporate and address the following safety points presented in the form of a check list by functional area This list is not intended as a complete and exhaustive list Each user must determine their own safety procedures and ensure that they are operated correctly and consistently WARNING The checklists are in two sections as follows one for the routine users of the system Adding editing patient s details Adding editing patient treatment plan Adding previous treatment history Running clinics monitoring patient results Adding the next test date time Adding editing deleting user letters messages Adding Editing Deleting Patient Questionnaires And secondly there are separate check lists for system managers to consider Dose interval settings and Dose Instruction formats and messages letters email faxes Clinic diary Settings Procedures Letter
98. number compliance is in force The national number is always displayed with the caption NHS Number regardless of any entry in the PatientNationalNo FieldCaption system setting drop down list is displayed for NHS Number status The list contains all 8 possible options for NHS number verification status 2014 Enforcing Mandatory Use of the NHS Number a Trace required Trace needs to be resolved Trace in progress Number not present Trace ed ba Where the NHS number is blank the default status is Trace required Where the NHS number has an entry the default status is Number present but not traced When you enter or amend an NHS number e DAWN checks whether the number you entered is valid If your entry does not pass the validation check the system displays an error message and prevents you from saving the invalid number s Last name First name E NHS Number status Trace re 12 Address 1 Mail Address 2 Town County Post Code Sex Male ll DoD Ethnic origin Caucasian Language None selected Status Active e f your entry is valid DAWN reformats the number in 3 4 format and updates the status to Number present but not traced NHS Number 112 345 6789 NHS Number status Number present but not traced e f you have the relevant User Profile
99. page 38 List of Clinics 83 List of Diagnoses 103 2014 46 Dawn Version 7 E Manual List of Diagnosis Groups 115 List of Diagnosis Stages 118 List of Drugs 106 List of Events 109 List of Health Authorities 49 List of Healthcare Professional Types 69 List of Healthcare Professionals 72 List of Lookup Tables 146 List of Message Events 130 List of Message Templates 127 List of Organisation Types 52 List of Organisations 55 List of Patient Allergies 97 List of Patient Groups 61 List of Procedures 112 List of Wards 58 List of WarnLevels 121 list 374 List Views What are They 142 list 374 LMWH Pentasaccharide Agents 328 LMWH Instructions Adding 237 Validate 246 Logging In Active Directory 171 Logging into Dawn 35 Login Confirmation Screen 44 Login Screen 44 Lookup Tables What are They 145 Maintenance 221 Bridging 369 Induction 369 Procedure 369 Manual Links 16 Manual LMWH Regime 338 Mapping Printers to Paper 163 mark as completed 400 418 Messages 201 Miss or Bosst Days Multi Tablet Instructions 248 Multi Strength Regime 286 N Navigate 40 New Date 207 New Patient Form 176 New Ward Form 59 Next Test Date 199 No Dose Change 198 non attendance 209 434 non attender 434 Non Attending 210 nonVKA 375 non VKA 973 non VKA 375 Not Today 191 Organisation Adding 53 Editing 53 Organisation Form 56 Organisation Ward Adding 56 Edit
100. permissions you can change NHS number verification 2014 4 Dawn Version 7 E Manual status by selecting a different option from the list The most common reason for changing the status is to confirm that the NHS number has been traced and verified as the correct number for this patient by changing their NHS number status to Number present and verified If Full Compliance is in force NHS numbers are suppressed on all printed letters and reports and electronic output such as emails faxes and outbound interface messages that would usually contain the NHS number where the patient s NHS number status is anything other than Number present and verified For example This is a letter for a patient whose NHS number status is Number present but not traced 4 4 3 m mi Dawn Hospital Anticoagulant Monitoring Service Newcastle Upon Tyne Tyne amp Wear 11 YTG Tel 01539563091 Mr Hedley STEPHENSON Hosp No H67 2563 5f Woodman Cottages Colliery Row mE Towbank Date of Birth 01 07 1942 Co Durham NR56 Treatment Plan Anticoagulant Warfarin ATRIAL FIBRILLATION Diagnosis Target INR Range Start Date Duration 2 0 3 0 2 5 Target 07 07 2006 Indefinite This is an extract from the same letter for the same patient once his NHS number status has been set to Number present and verified 2014 Enforcing Mandatory Use of the NHS Number 451 7 FL ant sa E a Dawn Hospital
101. printed or issued from the computer must be reviewed by an experienced healthcare professional before being given to the patient 2 Ihe customer must ensure that the most appropriate therapy management regime is used for the patient based on their indication and stability status Patients classed as unstable examples of patients within this category are outlined within the Safety Manual for Anticoagulation should be segregated and treated separately from stable patients 3 The customer must have a procedure to ensure rigorous follow up of non attendees and ensure that all patients have a next test date 4 To operate the system successfully a computer literate person is required This person should be able to drive application programs manipulate the PC operating system for example to copy files and backup the data held on the PC 5 The customer must ensure that only personnel that have been adequately trained in the use of the software and the safety instructions should operate the system 6 The customer must operate the system in accordance with the Safety Manual for DAWN AC 7 Prior to initial use and following any software upgrade or change to the software settings an appropriate and thorough validation exercise of the software should be completed for your local way of working before live operation This shall include a test of dose instructions and test intervals covering the full ranges of INRs and all o
102. regime to an alternative regime for the same anticoagulant To change a patient s anticoagulant you must start a new Treatment Plan 3 Each Anticoagulant can have one or more tablet strengths and each Regime holds details of the tablet strength or strengths used Regimes where instructions are expressed in mg just hold details of the minimum tablet strength used 4 To allow for differences in e Tablet colour and tablet strength among different regions such as the USA or UK and e Tablet shape among different commercial brands within the same region such as Coumadin and Jantoven in the USA you can define different brands of tablet for example Coumadin Jantoven UK generic An anticoagulant can have a several tablet strength records for the same strength tablet each belonging to a different Brand This allows you to use different images captions and Display Names for different brands of the same anticoagulant 2014 Anticoagulants Dosing Regimes and Instructions warfarin 5 You can specify which brand of tablet each Regime uses and you can change from a Regime which uses one brand of tablet to a Regime using a different brand of tablet at any point in a patient s treatment so long as both brands are for the same anticoagulant 6 DAWN AC version 7 7 introduces improved ways of presenting dosing instructions including the ability to express dosing instructions in up to three different tablet strengths to
103. risk of a bleeding event The study found that a calculation of Percentage Time in Range over a 6 month period can help in indicating increased risk of thrombotic events with patients in the Below Average range 3796 having 3 3 times the risk of a thrombotic event compared with patients in the Above Average range gt 82 9e TIR The same study also found that a calculation of the variability of the patient INR over 3 months can indicate a 3 3 times increase in the risk of any event thrombotic and bleeding for patients in the most unstable group VGR 0 67 compared with those in the most stable group VGR 0 10 Functionality to calculate and display two traffic light indicators for 6 Month 9e Time In Range and 3 Month VGR along with a cross check Maximum Difference in INR value is therefore available on the main Patient Details screen from version 7 9 33 of DAWN AC 1 Ibrahim S Jespersen J Poller L on behalf of The European Action on Anticoagulation The clinical evaluation of International Normalized Ratio variability and control in conventional oral anticoagulant administration by use of the variance growth rate J Thromb Haemost 2013 11 1540 6 2014 Variance Growth Rate VGR 4 VGR Field Calculations and Display VGR Setup Screen A new VGR Setup screen has been created Ranges of TIR and VGR values are defined on the VGR Setup screen and associated with different descriptions and
104. smallest tablet strength is 3mg and the smallest permissible part of the tablet is half a tablet the dose you specify for each day must be divisible by 1 5 25 3 6 Adding LMWH Instructions 1 Select the LMWH drug or Pentasaccaride agent from the drop down list 2014 238 Dawn Version 7 E Manual Dosing uu Y Y M IHR 2 4 InRange Sun Mon Tue Wed Thu Fri Sat T Jane seleg ted Enoxaparin D alteparin Tinzeparin Fandaparinux D ase 50 00 Al Next I2 082009 dose change Status Tested Accept dose oa ime nrange Comments T T T T wed 2407 009 wed Uem 2009 Wied 01 ns Fri 26 06 2009 Fri 15 05 2003 2 2B 2 4 2 6 50 00 w ifl 50 00 w ifl 50 00 w ifl 50 00 w ifii 20 00 w ifl 3 wk A wk EM 71 A B wk 14 04 2009 2 6 Wed 08 04 2009 2 1 07 04 2009 2 7 21 00 w gh 21 00 ve 21 00 ve 21 00 ve hon 06 04 2009 2 1 The options displayed depend on the settings for the LMWH drug you select see Setting up LMWH and Pentasaccharide Agents 2 If the drug has no LMWH Drug regimes or syringe sizes defined the default dose for the drug is displayed in an editable field which you can modify where necessary by over typing the default value with the required value If no default dose has been defined for the drug the dose field defaults to O 2014 Anticoagulants Dosing Regimes and Instructions warfarin
105. taken into waRNING ACCOUNT 25 4 2 7 Activating Deactivating and Maintaining regimes Before you can use a new regime you must activate it If you then need to make changes to it you must change its status to In Maintenance If you no longer wish to use a regime you can Deactivate it The following sections explain these workflow states and describe how to move from one to another 25 4 2 7 1 Regime Work Flow States Dosing Regimes have the following workflow states 1 New Initial status a Regimes that are Newdo not appear in the Regime selection list on the Treatment plan form b Newregimes have never been activated so they have never been available for selection Consequently no patients are ever on Newregimes C Settings for Newregimes and their instructions can be altered 2 Active In use a Active regimes appear in the selection list on the Treatment Plan b Instructions for Active regimes can be used in Dosing patients C Settings for Active regimes and their instructions cannot be altered 2014 Dawn Version 7 E Manual In Maintenance Being Edited a Regimes n Maintenance do not appear in the Regime selection list on the Treatment plan form b Patients may already be on a regime when its status is changed to n Maintenance n this case the instructions cannot be used while the Regime is In Maintenance C If you attempt to dose a patient on a Regime that is n Maintenance an
106. that the computer recommended next dose is based on the last dose recorded for the patient if that is wrong then the next dose will be wrong or inappropriate Be aware with Maintenance Module that the computer next test interval is based on the stability of the patient indicated by the length of the last test interval and the INR this time If the last test interval is wrong then the next interval will be wrong or inappropriate Be aware that with Maintenance Module the inbuilt algorithms do not take account of interacting medications previous adverse events previous and planned procedures Be aware that DAWN AC can provide visual warnings of the presence of any recorded and current interacting medication previous adverse events previous and planned procedures Ensure all entered INR results are correct and have been entered against the correct patient with the correct test date Check any manual override of the dose and next test date and always add a comment to say why the change was made Check any manual override of missing or boost days and always add a comment to say why the change was made The patient MUST be stable and reached a maintenance dose before using automatic dosing in the Maintenance Module Validate each dose and next date BEFORE informing the patient Where appropriate consider calling patients to discuss any changes in their dose If patient record books with labels are being used check the correct d
107. to 02 Number present but not traced If you go straight to full compliance you will lose the ability to include the NHS number on all such output for each patient until you change their verification status to 01 Number present and verified If you are making these updates without 2014 Dawn Version 7 E Manual 28 2 the aid of an interface this process may take some time On the other hand leaving compliance switched off prevents you from recording the verification status this option is hidden and disables automatic validation and reformatting of any numbers you enter Validate and Verify only allows you to update each patient s verification status and apply validation and reformatting without suppressing the NHS number on all output You can switch to full compliance later when all your patients have the correct NHS number verification status recorded To switch on Validate and Verify Only or Full compliance open the NHS Number Compliance Control Panel as described in the section Switching NHS Number Compliance on or off Switching on NHS Number Compliance To enforce compliance with the NHS directives governing mandatory use of the NHS number perform the following steps 1 From the System menu choose Management System NHS Number Compliance to open the NHS number Compliance Control Panel NHS Number Compliance Control Panel NHS NHS Number Compliance NHS Compliance for National Numbers is only applic
108. top to display its current settings Where the Dosing EnableCustomizeaWeekPatterns System Setting is set to 1 True the AllowCustomizedW eekPattern setting is displayed in the Treatment section of the User Profile form 2014 24 Dawn Version 7 E Manual Treatment AllowSchedule Treatment AllowUnScheduleTreatment High AllowEnterAndAccept INR High AllowDNAtreatment High AllowTestFailedTreatment High AllowAcceptDose High wj AllowAuthorise High AllowResetTreatment Li N AllowtustomizedWeekPatterns 3 Select this checkbox to allow all users with this profile to customise instructions Deselect this checkbox to prevent users with this profile from customising instructions After changing User Profile settings you must log out and log back in before the new settings take effect for your current login 25 3 15 Plain Text Non DayPattern Instructions Plain text instructions are defined purely as text see Setting Up Regimes and Instructions Regimes and Instructions Creating Non DayPattern plain text instructions An example of a plain text instruction might be INR 2 3 InRange Date 15 07 2009 Y 5 my DAILY 2014 Anticoagulants Dosing Regimes and Instructions warfarin 265 INR 2 2 InRange Date 28 07 2008 Y Smg MON FRI SAT SUN 1 The cycle button is disabled for plain text instructions 25 3 15 1 Customising Pla
109. work in Daily doses 2014 258 Dawn Version 7 E Manual 2 If the dosing regime does not include an instruction that can exactly match the dose specified for the number of days until the next test it rounds the dose to the average or total dose for the nearest dosing instruction The Induction dosing algorithm sees this as taking the patient off protocol and prevents further Induction dose calculations 3 If you select a weekly dosing regime for a daily Induction Algorithm or vice versa you are prevented from adding tests as history or next appointments or from entering INR s for the patient Instead a message box appears asking you to select the appropriate type of Regime for the Induction Algorithm e g Please select a Daily Regime for this Induction Algorithm o If you do not already have appropriate dosing regimes for Induction follow the instructions in the following section Downloading and Importing Default Induction Hegimes to import the standard DAWN AC Induction regimes 25 3 12 1 Downloading and Importing Default Induction Regimes If you started on DAWN AC version 7 7 or later you may have the default warfarin Induction Regimes These are warfarin Induction A Same Dose Daily Regime Using Average Daily Doses expressed in mg warfarin Inpatient Induction A plain text regime with instructions such as 5 mg per Day as Plain Text described in the section Working with Dosing Instructions Inductio
110. written DMA Letter Patient ManualMessage hal Letter Written 2014 Settings for DAWN 131 9 24 2 Adding a New Message Event MessageEvent New record B Template Patient message Send no message Nenut fKin message lt Send message GP message 4 Send message Consultant message lt 5 message HCprofs message 9 Keep informed level 4 Mone selected HCProfessionalType 4 None selected Clinic iewTableMessageEy E frou will need to save this new record before you can add relatec InUse PrinterPaperType None selected 9 25 Setting up a Cessation Reason Different cessation reasons can be set up within DAWN so that this can be chosen within the patient s treatment plan Please note once a cessation reason has been added into DAWN the cessation reason will then become a mandatory field to fill in within the patient s treatment plan 2014 132 Dawn Version 7 E Manual LicenseAgreement Welcome License MaxActivePatientCeur Fou are comendd an ar Support 45 wat user prone Top Grade Frontpage Normal Tables A e 2 Lookup tables AW N AL Anticoagulation Tables RAI ib Allergy BloodGroup Diagnosis E 1 7 Patient view Druginteraction oe EthnicOrigin e
111. your search value to 0123456789 012 345 6789 Likewise if you type 012 345 6789 DAWN automatically updates your search value to 012 345 6789 0123456789 2014 454 Dawn Version 7 E Manual 28 6 Patient ldentifiers in Screen Titles If mandatory NHS Number compliance is not in force DAWN includes either the Unit Number MRN Hospital Number etc or the National Number in the title of screens such as Patient Treatment Plan and Treatment depending on which is set as the mandatory patient identifier system setting PatientUnitOrNationalNumber When you switch on either level of mandatory 5 Number compliance DAWN always includes the NHS number in the screen title for these screens regardless of whether it is the mandatory patient identifier It also displays the short code for the NHS number s verification status e g 012 345 6789 01 Astatus of 01 means the NHS number has been verified Any other status means the number has not been verified The table below shows the short codes and full descriptions for the possible NHS number statuses Short Code Description 01 Number present and verified 02 Number present but not traced 03 Trace required 04 Trace attempted no single match 05 Trace needs to be resolved 06 Trace in progress 07 Number not present and trace not required 08 Trace postponed baby 6 weeks old If the unit number is the mandatory patient identifier the screen title includes both the
112. 0 In part instr x Line3 In part instr x Line4 In part instr DayPattern x Sun Mon Tue Wed Thu Fri Pills 6 rg be vs vs Vs Pile 744mg Pills 10 mg 10 3 3 3 3 Recalculated instruction for a dose Any existing Line 3 and 4 text is replaced with the caption for the smallest tablet strength These lines are not used when showing formatted instructions They are only displayed in Compatibility mode or for non day pattern instructions 5 Check all your instructions carefully and edit those that would be better achieved using a combination of tablets to use the optimum combination For example change LowerLimik 32 25 UpperLimit Se 5 Total dose 32 50 Line1 Sun Hon Tue Wed Thu Fri Sat In part instr Line 5 du In part instr X Line3 In part instr x Line4 In part instr E DayPattern lt Sun Mon Tue Wed Thu Fri Pills 1 mg LL 5 di 5 4i dA 415 Pills 3 mg Ll Pills 5 2014 306 Dawn Version 7 E Manual LowerLimit Total dose Line1 Sun Hon Tue Wed Thu Fri Sat In part instr 5 du In part instr IX instr 6 2 7 DayPattern Pills 1 Pills 3 mgl Pills 5 mg 6 When you have finished updating your instructions follow the advice in the section Tips on Creating Dosing Instructions Val
113. 0 in the Measured Creatinine Clearance or Serum Creatinine boxes Similarly for results which are reported as greater than a value like gt 220 please enter the numeric value like 220 The limits used for creatinine clearance are set as follows in DAWN less than 30 severe greater than equal to 30 and less than 50 moderate 2014 New Oral Anticoagulants Section 4 greater than equal to 50 mild The DAWN system alerts you if you add an unusually low or high serum creatinine or body weight measurement If you get a warning message please check the details you entered carefully back to Complete a Follow up page 2 2 3 2 5 Hepatic impairment If your patient is known to have hepatic impairment tick the Hepatic impairment checkbox In some studies hepatic impairment is defined as liver enzyme results greater than twice the upper limit of normal Hepatic Impairment Liver Enzymes gt ZULN Other Blood Checks P You may wish to add details of other blood tests in the notes box for later reference Note some anticoagulants may not be recommended in patients with know hepatic impairment back to Complete a Follow up page 27 2 3 2 6 Contraindicated drugs Some concomitant drugs may be known to be contraindicated for the chosen anticoagulant as published in the prescribing guidelines Please tick any drugs if your patient is currently prescribed this drug Contraindicated Drugs
114. 0 05 0 4 8 3 1 3 5 2 00 1 50 0 4 8 3 1 3 5 3 00 2 50 0 4 8 3 1 3 5 4 00 3 00 0 4 8 3 1 5 0 5 00 3 00 0 4 8 3 6 5 0 1 00 000 4 4 8 3 6 5 0 2 00 1 00 0 4 8 3 6 5 0 3 00 2 00 0 4 8 3 6 5 0 4 00 250 0 4 24 2 Maintenance Dosing Maintenance therapy is used for a patient when the patient has reached a stable maintenance dose DAWN uses an inbuilt algorithm to suggest the most appropriate dose and next test interval for a patient You can start a patient on maintenance therapy by selecting the options shown below when you create or edit their treatment plan 2014 222 Dawn Version 7 E Manual Disease area PrimaryDiagnosis B Anticoagulation AFACARDIOVERSION 01 03 2010 for the Maintenance Disease area Anticoagulation PrimaryDiagnosis CARDIOVER SIO Target range 20 s 0 g 5 Targ Start date Regime warfarin Img Whole Tablets in Duration type LongTerm Induction algorithm Mone selected Indefinite Sample instruction Sun Mon Tue Wed Thu Fri Sat Preferred clinic 3 qe a 300002005 4nticoag Clinic H 5 MG PER DAY Preferred time From until i MaxPercentDoseChange Status active ee Maxinterval ProblemPatientFlag 1 Recalt time in range Once the treatment plan is set up the DAWN system uses the previous INR and dose history combined with the current INR entered to suggest a dose and next test interval for the p
115. 0 94 1 88 za 2 50 4 38 das 5 B3 5 00 Microsoft Internet Explorer Error updating Instruction with average dose of 0 94 Please select tablets For all given Eablet sizes in Ehe regime MaxInstructionDoseIncrementk 70 Defaults for new instructions DayPattern iu ci Pod I part instr Pd part instr 82 Inpartinstr OR if the regime fails any of the validation checks described in the section Activating Deactivating and Maintaining Regimes Activating a Regime Validation Checks 25 6 5 Switching off Compatibility Mode Once you have activated your regimes you can use them in dosing patients However by default dosing instructions for upgraded systems display in Compatibility Mode In Compatibility Mode dosing instructions display and print just as they did in pre 7 7 versions of DAWN AC For example INR 2 5 InRange Date 09 07 2009 Y w5 Not scheduled Sun Mon Tue Wed Thu Fri Sat White tablet s 10 strength M Ma dose change Dose Status Tested 2010572009183 Y Accept dose 2014 352 Dawn Version 7 E Manual If you want your dosing instructions to display and print using the new formatted HTML style you must switch off Compatibility Mode To switch off Compatibility Mode 1 Choose Management System System Setting from the System F5 menu 2 Locate the AC Display
116. 0 w ifl Y Thu 09 07 2009 28 awk 3 Y Wed 24 06 2008 1 7 18001 7d NELLE Y Wed 17 06 2008 3 4 14 00 w T d SEEN Y w ed 3 6 2008 27 16 00 wif 2 wk Y Wed 27 05 2008 4 3 18 00 1 7d Wed 2005 2009 24 21 00 Ww 7d 25 3 11 Retrospectively Adjusting the Last Dose You can use the information icon in the Patient History to view the last dose instruction the patient was advised to take and compare it with the tablet pattern the patient informs you that they have actually been taking 2014 Anticoagulants Dosing Regimes and Instructions warfarin 253 IMR Mok scheduled Schedule manually warnings Treatment notes dose zero Dose 0 00 w Status Scheduled 88 Accept INR DNA Un schedule bose Comments Thu 30 07 2009 0 0 0 00 ve d Y Thu 09 07 2009 zu E m H Wed 24062009 17 16 00 ve i Warfarin Sun Mon Wed Thu Fri Y Wed 1706 2009 3 4 14 00 vv di mg 1402 44 4 H Wed Damer2na a ar 16 00 w di 2 vk H Wed 27 05 2008 4 3 18 00 vv di iq Wed 20 05 2009 2 1 21 00 w di iq If the patient has not been taking the tablet pattern they were advised to take the last dose is not an accurate basis for the current dose calculation Providing the current INR has not yet been entered and the dose calculated you can adjust the dosing pattern for the last dose to reflect what the patient
117. 1 Therapeutic Indication The dropdown menu for Therapeutic indication displays options for the primary diagnosis The available options are those set for any anticoagulant in the Lookup Tables as Therapeutic Indications Selection of the most relevant therapeutic indication for your patient is recommended If you are unsure you might wish to complete this later Therapeutic Indication None selected None selected Atrial fibrillation nonvalvular Total hip replacement surgery Total knee replacement surgen oee Lookup Tables to adjust the options displayed in this dropdown back to Initiation Questionnaire page back to Settings for New Oral Anticoagulants page 27 2 1 2 2 Qualifying Risk Factors Select the tickbox next to any thrombotic risks your patient may have Recording this information may be useful for later decisions on anticoagulation therapy Qualifying Risk Factors Aged gt 65 with diabetes mellitus coronary artery disease or hypertension Aged 75 or over Left ventricular ejection fraction 40 Previous Stroke transient ischemic attack or systemic embolism SEE symptomatic heart failure gt NYHA Class 2 The options displayed here are set in Look Up Tables as Qualifying Risk Factors back to Initiation Questionnaire page 2014 42 Dawn Version 7 E Manual 27 2 1 2 3 Renal function Estimates of renal function may be recorded in several ways on the Initiation Qu
118. 10 Organic lesion at risk of bleeding Severe renal impairment CrCIz30ml min The list of contraindications displayed on the Follow up Questionnaire may be edited added to by your system administrator using the Look Up Tables called Risks and Specific Risks NB any risks identified on the Initiation Questionnaire will NOT automatically display at the top left of your patient screen You may wish to highlight these manually on the patient screen either by adding Risks for a new patient or clicking on the Risks button to add risks for an existing patient screen 2014 4 Dawn Version 7 E Manual Risk dass High d Pref dinic Mone selected Phone home Age Atrial fibrillation nonvalvular NHon VKA 05 09 20121 Dabigatran 150 mg twice daily 2 Mew back to Complete a Follow up page 27 2 3 2 10 Haemorrhagic risks Please tick any of the risks which apply to your patient These risks are identified in prescribing guidelines as significant risks for consideration in dosing decisions for Dabigatran Haemorrhagic Risks Active ulcerative Gl disease Bacterialendocarditis Brain spinal or ophthalmic surgery Congenital or aquired coagulation disorder Recent biopsy or major trauma Recent gastrointestinal bleeding Recent ICH The list of haemorrhagic risks be edited added to by your system administrator using the Look Up Tables called R
119. 3 09 2012 Dabigatran 150 mg once daly Current Lancaster 12 06 1934 98755472 Cerebral vascular accident Major Hospitalisabon back to reporting page 27 1 6 Other Non VKA agents Questionnaires Please note this module can provide support separately for other agents besides Dabigatran etexilate through specifically designed questionnaires for each agent Please call for a quotation Also future releases for the DAWN AC Dabigatran module are planned to include a questionnaire for perioperative situations Contact 4S DAWN Clinical Software for more information at sales 4s DAWN com support 4s DAWN com 015395 63091 click here to go back to Overview page 27 2 Detailed Non VKA Workflow The following workflow describes how to add and deal with a new patient on non VKA therapy or edit an existing warfarin patient so that are logged as being on non VKA therapy The essential steps in recording non VKA anticoagulation are as follows 2014 1 Check if the patient details are already on DAWN AC 2 Add the patient details identification numbers name and address etc or update a previous record as required section 10 3 Complete an Initiation Questionnaire section 6 1 4 Stop any existing treatment plan for other anticoagulant or dose section 6 2 3 5 Activate a treatment plan for the chosen anticoagulant and dose section 6 2 1 6 Schedule the next follow up as a Follow Up Questio
120. 4 336 Dawn Version 7 E Manual 25 5 2 1 Creating an automatic LMWHDrugRegime LM TWHdrug Name DisplayName DoseUnits Dose per 1 Min dose Mg dose Mg Dose LMWHdrugSyringeSize ic pU RENE lick here bo HanuialRegime WeightBase x i Manual 1 ma per kg once day 1 ma per Ka 12 ig 1 5 per once a day C 30 mg once a day 30 mg q12h 40 mg once a day TIT 5 OrderMr Inlise 1 Click the new record icon beside the LMW HDrugRegime list to add new LMWHDrugRegime 2014 Anticoagulants Dosing Regimes and Instructions warfarin I MWHdrugRegime Lovenox New record Name 1 mg per kg 12 ManualRegime WeightBased x LowerLimit UpperLimit Mormalbose LH WHdefaultFrequency One dose 12 hours v x 2 Enter a name for the Regime This name is displayed in the selection list of regimes for this drug so it must accurately describe the dose and frequency e g Lovenox 1mg kg q12h 3 Name is a required field You are prohibited from saving the record without a name 4 Do not select the ManualRegime checkbox as you are defining an automatic regime When the ManualRegime checkbox is not checked you define the Dose and Frequency settings in the regime itself When you subsequently select this regime for a patient the dose and frequ
121. 4 FAQ non VKA records on DAWN AC Q Problems activating a treatment plan Check the following 1 Is the patient is marked Active You may need to click on Activate or Re activate the Personal tab 2 ls an Initiation Questionnaire is You may need to complete a questionnaire which is showing with a dose on the still marked as Scheduled Questionnaires tab Has the Initiation Questionnaire has Check that the same diagnosis and dose have different details been chosen in both the treatment plan and Initiation Questionnaire 4 ls the Initiation Questionnaire Check that the therapy is suitable for the age marked as contraindicated diagnosis other medications if it is your DAWN AC settings may need to be updated by your system manager contact support 4s DAWN com for assistance Q Why is my patient not on the non VKA list view Check the following 1 Has the patient got a DAWN AC See adding a new treatment plan treatment plan for the non VKA agent 2 Have you chosen a date or clinic Adjust the filters on the left of the list view to see all filter on the left of the non VKA list view patients with a non VKA treatment plan which excludes this patient Q Why do get Contraindicated warnings Contraindications may be for inappropriate concurrent medications see interacting drugs 2014 New Oral Anticoagulants non VKA Section a29 or risks see haem
122. 5 3 Cessation Reason Form LessationReason New recor Name OrderNr InUse Les e E seu E El LE nl EA pr am d a iti t LII E Gata ENTER 9 26 Editing System Settings System settings are global settings that help tailor the behaviour of different aspects of the application This section does not discuss what all the different system settings do as that would take them out of context Instead they are discussed individually in the context of the chapters to which they relate However this section describes how to amend a system setting To change a system setting 2014 136 Dawn Version 7 E Manual 1 Press the System Menu button to display the system menu 2 Choose Management System SystemSetting from the menu to display the SystemSetting form LicenseAgreement License MaxActivePatientCoun Frontpage Normal Tables Lookup tables Reports Management Clinic View settings C3 MessageManagement Printing Reports Parameter Report Polar Reporting Audit amp security DawnInterface DataExchange CustomModule NHS Number Compliance CodedComment 3 Type the name or part of the name of the system setting you wish to change in the Search For Name field and press the Search button 4 The SystemSetting form displays any system settings matching the name you typed SystemSetting
123. 7 E Manual Windows Internet Explorer 25 4 2 7 3 Maintaining a Regime To maintain an active regime 1 Choose Lookup Tables Anticoagulation Tables Regime from the System menu to display the list of existing dosing regimes 2 Select the Regime you wish to activate from the list and press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document Windows Internet Explorer wWARNIMG You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again to accept these terms and to edit the data 3 To accept these terms press OK and then press the Edit button again as directed in the message box The edit dosing regime form is displayed 2014 Anticoagulants Dosing Regimes and Instructions warfarin 323 MEV Vyarfarin 1 amp Smg Tablets with Halves In Maintenance A Undefined weekly m WARFARIN 1 Mi WEEKLY DOSE Weekly Active
124. 7 Patient Switched to Manual Bridging Therapy d Scheduled For Thu 29 04 2010 09 00 13 00 Pref clinic in clinic LERAS Home Visit Reschedule manually Phone Age TERMI AE ICARDIO V 2 0 3 0 2 Et 1203 20 300 wks Due to stop 11 12 2014 A Vartarin 1 amp Smg Tablets4Aeekly with ane a E sd a This patient has been moved to manual bridging therapy as their dose change of 200 is outside the boundaries of normal maintenance ista i ging not switch the patient back to maintenance therapy until you are Fully confident they have achieved a stable maintenance dose 4 1 b ofi active Risk class Microsoft Internet Explorer 2 52 8 m fe Dose Time Inrange Comments Thu 29 04 2010 0 0 0 00 w 1 Y Thu 2204 2010 21 15 00 w amp LL Switched to manual therapy dose change gt 20 Thu 15 04 2010 2 1 5 00 w i Y Thu08m42010 25 000 7d B Anticoagulation 03 2 103 2009 300 active Disease area ACTherapy C Induction PrimaryDiagnosi Maintenance Start date Manual Bridging Target range 2 0 3 0 2 5 Target Regime NEW Warfarin 1 amp 5mg Tablets Induction algorithm None selected X Duration type Duration Preferred clinic le instruction Sun Mon Tue Wed Thu Fri Sat Preferred time From until entDoseChange active
125. Allergies 95 Adding Editing Blood Groups 98 Adding Editing Diagnoses 101 Adding Editing Diagnosis Groups 113 Adding Editing Diagnosis Stages 116 Adding Editing Drugs 104 Adding Editing Events 107 Adding Editing Healthcare Professional Types Adding 68 Editing 68 Adding Editing Organisation Types List of Organisation Types 50 Adding Editing Procedures 110 Adding Editing WarnLevel 119 Adjusting the Last Dose Retrospectively 252 adverse events 421 Amendinf further 196 Amending 193 Anticoagulants 267 Apixaban 375 Authorise Dose 200 Automatic LMWH Regime 336 Boost 197 bridging 223 431 Calendar 189 cancel changes 400 418 CHADS 408 427 Change clinic 368 change dose 412 change drug 412 changing anticoagulant 430 changing type 430 Clinic Adding 82 Editing 82 Clinic Adjustment Form 88 Clinic Diary Slots 91 clinic 374 Clinic Diary Screen 140 Cloning a Dosing Regime 299 Coded Comments 148 complete 400 418 compliance 420 Confirm 210 Contraindications 389 Creating a Tablet Strength 275 Creating an AC Brand 272 Creating new Anticoagulant 269 Creating the Diary 90 Custom Instructions Inhibiting 263 Permitting 263 Customer Software Use Obligations 32 Customise Plain Text 265 Customising Instructions Permissions 354 D Dabigatran 373 dabigatran dose 412 Dabigatran 375 Data Exchange 156 2014 Date Today 192 Day Pattern Dose Instructions 229 a G Day Pattern Instru
126. Class Reports Application rea Custom reports DiagnosisGroup DiagnosisStage Settings Discipline Modify your personal settings MeetingType DrugDoseUnits i inti i Select a location Current location For printing 9 12 1 Severity of Risk Setting From the Lookup tables set Severity for Risk 2014 Settings for DAWN AC 9 Severity Search for Description Severity Type Drug er Event Description Order Major Hospitalisation fo Moderate Hospitaisation m Moderate uo ostro JA Risk Description Order NN Gf 9 12 2 Risk Add or edit Risk from the Lookup tables on the F5 menu 2014 94 Dawn Version 7 E Manual 2572 Warntevel Moderate No Hospitalsation l Jalwayswan 9 conol o Moderate No Hosptalsation Wolnym GROOKER CENTRE PATIENT Moderate roseis Mie uWerwem cor cancer Moderate NoHosptalsation EAVETOHUSE Moderate NoHosptalsation PHARMACEUTICAL Ud Moderate No Hosptalsation E Q Amayswam PAEDIATRIC PATIENT Moderate No Hosptalsation E Q Amayswam pRoteIncoericiency _ MODERATE 2 ok rc
127. D SCONES 408 Non VKA treatment 409 Staning anom YVRKA trealment pla eub a t vtta 409 Changing treatment 412 414 415 Schedule a Followup Non VIKA Iv reat vends 417 Contents Part XXVIII A c N Part XXIX 2014 1 Complete a Follow up 1 enne nn nnne 418 Patient questions over past 2 W eekszau m en CODD ane ves EH UR EE EE FREIE KS 420 Reasons tor compliance problems cu eas c tibi rv ERE Dv D rU RD 420 Adverse events TeDOFIQ ON Ex C ERR 421 wi Bises 421 MEER Hn D T 423 Contraipcdieated bua beri die sq
128. D scores notes for planned procedures or other comments Dabigatran dose amp You should ensure that the questionnaire content is appropriate for the current 2014 New Oral Anticoagulants non VKA Section 377 recommendations drug manufacturer A Follow up may be scheduled for patients starting on Dabigatran and the history for questionnaires is easily viewed on the Questionnaires tab Questionnaires est Results Interface E Questionnaire ype Entry date Dabigatran Follow Up 02 07 2012 Overdue ey Dabigatran Initiation 15 06 2012 CrCL mL min 91 Dose 110 mg twice daily Patient details will appear on your Non VKA list view when the date of the next follow up is due back to Overview page back to Settings for Regime and Dose Settings page 2014 378 Dawn Version 7 E Manual 27 1 3 1 Dabigatran Initiation Questionnaire Dabigatran Initiation Patient Name Bertha Black Due Date 18 02 2012 Unit 32423452354 Status Scheduled Questions Therapeutic Indication Atrial fibrillation nonvalvular Qualifying Risk Factors Aged gt 65 with diabetes mellitus coronary artery disease or hypertension Aged 75 or aver Left ventricular amp jection fraction 40 Previous stroke transient ischemic attack or systemic embolism SEE Symptomatic heart failure gt Class 2 Duration of use Short term Measured Creatinine Clearance mL
129. Deceased If no Patient Deceased cessation reason exists for anticoagulation or whichever disease area the Treatment Plan belongs to DAWN automatically adds one DAWN then records Patient Deceased as the cessation reason for the Treatment Plan If you wish to use a different cessation reason for deceased patients for example you may already have a cessation reason called simply Deceased you can specify which cessation reason to use by amending the TreatmentPlan DeceasedCessationReason system setting SystemSetting Sorting Last changed 7 mizations Vale Description reatmentPlan DeceasedCessationReason Patient Deceased Cessation Reason to use when automatically stopping a treatment if a patient is marked as deceased See the section Editing System Settings for instructions on how to change System Settings See the section Setting up a Cessation Reason for more details on Cessation Reasons 2014 188 20 Dawn Version 7 E Manual Dosing a Warfarin or other Vitamin K antagonist Patient This section gives a workflow of how to dose a patient within the DAWN system and give them a next test date Risk class Anticoagulation Clinic 12345 Pref clinic 610 345 7623 home v Age 16 ATRIAL FIBRILLATION Diagnosis 2 0 3 0 2 5 Target WARFARIN MIXED TABLETS WEEKLY 01 02 2009 200 wks Stops 02 12 2012 Trestmentb
130. Drugs If you need to add a drug that does not exist in the standard list new drugs can be added here 2014 Settings for DAWN AC 105 License MaxActivePatienti ount Fou are currently fogged an ar Support 45 th user proie Tap Grade Frontpage Normal Tables CLINICAL Lookup tables ANI A Anticoagulation Tables FRAMEWORK j e Allergy GloodGroup amp Diagnosis e Drug Cruginteraction EthnicOrigin e Event HOProfessionalType JournalltemType LetterTemplate aAntbicaa Patient view Sax add edit or dose a patient List view Daily routines Attendance and nan attendance Mais Diary OrganisationType Consult the diary Procedure Message center even v Manage messages and pass messages by p Severi Type RiskClass 3 Reports Applicationarea a m Diagnosisiroup DiagnosisStage Settines 2014 106 Dawn Version 7 E Manual 9 16 1 List of Drugs Relevant interaction Relevant for EE 3 a pgoxvcvcLINE None selected BI anticoagulation clinical Haematology Rheumatology EB lacETAZOLANIDE None selected anticoagulation PS clinical Haematology Rheumatology BI Anticoagulation clinical Haematology Rheumatalagy BI Anticoagulation clinical Haematology Rheumatalagv ione selected Anticoagulation clinical
131. Green X ru rderNr 10 X 1 If an anticoagulant is available in different tablet strengths you can define a Tablet record for each tablet strength 2 As different regions or brands may use different tablet strengths or different tablet colours and shapes for the same strength you can define different tablet records for different brands 3 Choose Lookup Tables Anticoagulation Tables Anticoagulant to select the appropriate Anticoagulant record The Tablet records for the anticoagulant are listed under the Anticoagulant details The Tablets are grouped by Brand 4 Click a Tablet Caption to display the Tablet add edit list 2014 274 Dawn Version 7 E Manual AnticoagulantTablet Warfarin Sorting ByRegion BySize J E xa S s Barr USA Warfa id Tabletsize Caption AltText Notes nse Image pm 198 gt bo i2m lavender Cd amp espis 1 Jj Cd amp 1 B amp 400 Pils sm je y amp so pis 5m Peach 1 1 D 1 11K amp mo A amp zx pirmg 146 amp opis 10mg we J Cd Coumadin iin Don LICHEN D RN Notes nse Image 3 ropita e o Z 3 2 00 pils 2mg lavender 184 o u ma eee ra NAA bu 222 3 Pils 6 mg 5 By default the tablets are sorted by Brand Region then by size You can also choose to sort
132. Haematology Rheumatology ___ None selected Ar Anticoagulation x clinical Haematology Rheumatkalagy ALKA SELTZER selected Anticoagulation x clinical Haematology Rheumatalagy au LoPuRTINOL Click here T anticoagulation clinical Haematology Rheumatology FES a AMILORIDE 0 2 Lit BE annicnanilatinn aay Downe Details Point 2014 Settings for DAWN AC 9 16 2 Adding a New Drug Drug New record me can be added Relevant interaction None selected Description Drughotes Relevant for InUse Customization 1 LustomizeDrugForPatient PatientCustomizationNotes Dutton save this record 9 17 Adding Editing Events If you need to add an event that does not exist in the standard list new events can be added here Eel LEE ub 2014 Dawn Version 7 E Manual 9 License Max amp ctivePatientCount yes are currently fogged an ar Support 45 ath user profe Tao Grade 5 Frontpage Normal Tables 5 Lookup tables Anticoagulation Tables e Allergy GloodGroup amp Diagnosis Drug Anticaaqulat Patient view C Druginteraction add edit or dose a patient EthnicOrigin Evert m E HCProfessionalTvpe JournalltemType LetterTemplate OrganisationTvpe
133. Haemorrhagic Risks section 4 1 2 9 and section Records for CHA2DS2VASc HASBLED scores section 4 1 2 12 Notes for planned procedures or other comments Once you have answered all sections click on as complete at the bottom of the questionnaire 2014 New Oral Anticoagulants non VKA Section 399 Status Scheduled Mark as complete back to Integrated non VKA VKA patient record back to Detailed Workflow page back to Settings for Regime and Dose Settings page 27 2 1 1 Schedule an Initiation non VKA On adding an Initiation Questionnaire change the Due Date to the date you will complete the details Dabigatran Initiation Patient Name Eddie Alderson Due Date 05 12 2012 E Unit Mo 078137 Status Scheduled Click OK at the bottom of the Questionnaire screen to save this Initiation with the scheduled date an Le Se E Sen F Questionnaires x m QuestionnaireType Entry date e Dabigatran Initiation 05 12 2012 Scheduled back to Initiation Questionnaire page 2014 4 Dawn Version 7 E Manual 27 2 1 2 Complete an Initiation Questionnaire The Initiation questionnaire is structured to help you record all relevant details at the time Dabigatran therapy is started See details of the Initiation Questionnaire section 4 1 I If you cannot answer some questions simply click OK or Save and come back later to compl
134. I New Oral Anticoagulants non VKA Section 373 1 Overview of New Oral Anticoagulants 2 2 0 0 0 00 00 211121 373 LU C LIST VIC v 374 Integrated non VKA VKA 375 Questionnaires for non VKA therapy management ccccceeesesseeeeseesseeneeneeeeeeeeseeeeeeoensesseeseneeeeeseeseeeooanens 376 Dabigatran hitiation Questi nfialle sus icc estere RR EP th Gn ues di ee aec oet ua Ganesh eds ska es RA EH M P de DUREE 378 Dabigatran FoloweupQuesHoFPfiallescscisctad voie lit abate tent cuit tea edits tonat Rd edebat Res 383 Help to follow recommended guidelines 388 CGT UP AIT NANG QUOTIS 389 PROTA PING E cea as Su ccn 390 Warnings inconsistency and cormpleleriess 4 oto end t 390 HDS UNG bo tone den ict eft te tance CAS 391 Overview en Std ue eal een Du motive a 392 Reporting on the non VKA patient database 393 394 BOME LL MEE EE LM LE 395 Other Non VKA agents sisirin aeae naaa aeaa aeaa
135. Le seii Cd part instr O Hec umes iver Cd part instr Pod tn part instr Clone Regime The Max Step settings determine how big the step between the average or total dose of one dosing instruction and the average or total dose of its adjacent instructions is allowed to be For example in the following regime showing a Total weekly dose the step between instructions is 0 5 mg per week Sun Mon Tue Thu 5 Total Dose 2014 Anticoagulants Dosing Regimes and Instructions warfarin 289 In other words each instruction tells the patient to take 1 2 mg per week more than the previous instruction in the regime This is easy to see in a Weekly Regime showing the Total Weekly Dose but the same holds true for a Daily Regime where the numeric dose is expressed as the Daily Average Dose The step between instructions is still v mg per week only here the difference between the average doses is 0 5 divided by 7 to give the average difference per day we obviously need to round this slightly These regimes use the minimal increments approach to creating dosing instructions described in the section Tips on creating dosing instructions Creating Dosing Instructions However regimes which use the Same Dose Daily approach described in the same section use a bigger step men free et e Dose o 9 2014 2 Dawn V
136. Line setting and specify that the Total mg line is always or never displayed for a particular Regime regardless of the system setting and tablet strengths used The following table describes the effect of each possible combination 2014 230 Dawn Version 7 E Manual AC ShowiInstructionTotalDos ShowInstructionTotalDose Total mg line displayed on instruction eLine System Setting o queeded Never ooo o Ced 7 5 If a default dosing instruction for a patient shows odd dose on one or more days e g 5 gt mg on Wed and 5 on all other days you can use the cycle button to move the dose for each day back one increment at a time e g Wed Tue Tue gt Mon Mon gt Sun Sun gt Sat etc If the instructions comprises multiple lines for different tablet strengths and or total mg the cycle button moves all lines in unison 6 In previous versions of DAWN AC all dosing instructions were plain text and the background to the patient s dosing instruction was shaded to denote the direction and size of a dose change Shades of pink red denote dose increases while shades of blue denote decreases The shade deepens with the size of the dose change A white background denotes no dose change In version 7 7 onwards formatted instructions have their own background shading to facilitate reading along lines or down columns Multi line dosing instructions can potentially fill the whole dosing instruction box obscuring the backgro
137. MeetingT ype DrugDoseUnits Current location For printing Select a location e DrugDurationUnits Settings Modify your personal settings 2014 112 Dawn Version 7 E Manual 9 18 1 List of Procedures Procedure eWwarburstion PostWarnDuretion Re 5 Eardioversion Always warn mob 1 WE n 1 Jf Denta always warn mob BT 2014 Settings for DAWN 113 0 18 2 Adding New Procedure Procedure New record Description WarnLevel w e PostWarnDuration 4 hetl Relevant for InUse 9 19 Adding Editing Diagnosis Groups If you need to add a diagnosis group for a diagnosis that does not exist in the standard list new diagnosis groups can be added here 2014 114 Dawn Version 7 E Manual License_MaxActivePatientCount Fou ate coment logged on ar Support 45 seth user prae Tap Frontpage gt Normal Tables Lookup tables Anticoagulation Tables Allergy GloodGroup Diagnosis Crug Cruginteraction Ethnicorigin Event HCProfessionalTvpe JournalltemType LetterTemplate COrganisationT ype Procedure Anticoaquilat Patient view C Add edit ar dose a patient List view Daily routines Attendance and non attendance Diary Consult the diary ot Message center even v Manage messages and pass
138. Notes 199 treatment plan 409 U Undo 194 Undo a Dose 363 Update Message Templates 353 Upgrading to 7 7 339 User profile Adding 62 Editing 62 User Profile Form 65 validation checks 392 W warnings 390 workflow 395 a Zero Dose 198 468 Dawn Version 7 E Manual 2014
139. Nr Inuse d od 4 2014 e Dawn Version 7 E Manual 9 7 Adding Editing Healthcare Professional Types If you need to add a type for a healthcare professional that does not exist in the standard list new types can be added here License Agreement Welcome 9 License_MaxActivePatientloutt rou are currently fogged an ar Support 45 with user profile Tan Grade Frontpage Normal Tables Lookup tables L Anticoagulation Tables Dn Pose VC Allergy to th T Anticoa Bloodaroup Diagnosis Crug Patient view C DrugInteraction add edit or dose a patient Ethnicorigin 222 List view Daily routines raressianat Attendance and nan attendance JournalltemType LetterTemplate E Diary Organisation Type Consult the diary Procedure Risk Message center Severity Manage messages and pass messages by ph Severity Type RiskClass Reports ApplicationArea Custom reports Diagnosisiaroup DiagnosisStage Settings Discipline Modify your personal settings Meeting ype Dini Dinsel niks 2014 Settings for DAWN AC e 9 7 1 Listof Healthcare Professional Types akan ee oe les 7 phamsis Phemass 5 Gms e K e k fens dD mer k Eonsukentnchergs Kcensukentincherge 15
140. OVERSION ANEURSYM ANEURSYM WITH EMBOLIC EPISODES ANGINA ANGIOPLASTY ANTI FHOSPHOLIPID SYNDROME 111 DEFICIENCY Non VKA 1 5 2 5 2 0 Target 2 0 3 0 2 5 Targat 2 5 3 5 3 0 Target 3 0 4 0 3 5 Target 3 0 4 5 3 75 Target 3 5 4 5 4 0 Target TargetRange Show report Download as XML Download as Text Email address Send AMAALLLL LUA A L CLLOOOLGC LP O APCAER7LLLLTT OL LV L CLLIL L L LO DGOGL Lou j AL1LLAALCj LL L AXdgLGO 7 TVCO LALLUABSCOOLLLELL OL OSLCO LLX a o pd Duration of Therapy Count Total of Total Magnasis Atrial fibrillation nonvalvular 0 Indefinite 2 4 50 Total hip replacement surgery 0 Indefinite 2 4 50 back to reporting page 2014 New Oral Anticoagulants non VKA Section 395 2 1 5 2 Example 2 Report EVENTS all areas Event Severity Minor Moderate No Hospitalisation Moderate Hospitalisarion Major Hospitalization Fatal Within How Many Days Of TP Start Date po Bleed lower GI A Bleed upper G1 Bleeding any other site Bruising unexplained Carabral haemorrhage Cerebral vascular accident Deep vein rhrambosis Diarrhoea and vomiting Anticoagulant Dabigatran 150 mg once daily T Show repart Dovenload as XML D avanload Text LIU IO Events all areas Event date Therapy RAS Humber ARN Even saa 0
141. The limits used for creatinine clearance are set as follows in DAWN less than 30 severe greater than equal to 30 and less than 50 moderate greater than equal to 50 mild The DAWN system alerts you if you add an unusually low or high serum creatinine or body weight measurement If you get a warning message please check the details you entered carefully back to Initiation Questionnaire page 2 2 1 2 4 Hepatic impairment If your patient is known to have hepatic impairment tick the Hepatic impairment checkbox In some studies hepatic impairment is defined as liver enzyme results greater than twice the upper limit of normal Hepatic Impairment Liver Enzymes gt 2ULN Other Blood Checks You may wish to add details of other blood tests in the notes box for later reference Note some anticoagulants may not be recommended in patients with know hepatic impairment back to Initiation Questionnaire page 27 2 1 2 5 Contraindicated drugs oome concomitant drugs may be known to be contraindicated for the chosen anticoagulant as published in the prescribing guidelines Please tick any drugs if your patient is currently prescribed this drug Contraindicated Drugs CICLOSPORIN MRACONAZOLE KETOCONAZOLE TACROLIMUS The list of drugs displayed are defined in the Look Up Tables on your DAWN AC database and additional drugs may be added to this list as required Please contact your system administrator to add new drug s
142. Writer Paper 44 E Medet HP Business Inkjet 1200 Series Paper 44 e Select save and the printing location will now be available to all users within the selected Organisation e Users can change their printing location from a drop down list on the main DAWN AC screen 2014 Setting up Printing User Guide Mon 29 06 2005 AW version 7 9 1245 T Anticoagulation A Patient view Q ak edit or dose a patient List view Daily routines Attendance and non attendance Diary gt Consult the diary Message center Manage messages and pass messages bw phone Reports Custom reports Settings Modify your personal settings Current location For printing 1 DC IE No of Active Patients Patients on Treatment Mow Missed Test z 1 Needs rescheduling next test date 2 Needs scheduling hile Ih ID 4 eee fot nad e he selected printing location is automatically saved there is no need to reselect the printing location each time the user logs in 16 6 Selecting Paper Type in Message Template e Press F5 to display the system menu and choose Management Printing MessageManagement Message Template e Select the PrinterPaperType for the message This will ensure that the selected printer will use the correct printer paper type when printing this message template e Choose Save 2014 168 Dawn Version 7 E Man
143. a selected regime from one list to Ehe other Moves all regimes to the Mot Selected For Import list import policy Far table Import Update existing Selected records X Required records x Automatic records Perform import updates 9 Press Perform import updates to import the records 10 Follow the instructions in the section Setting Up Regimes and Instructions Regimes and Instructions Activating Deactivating and Maintaining Regimes Activating a Regime to activate your new regimes 25 3 12 2 Induction dose validation 1 During the Induction phase if you edit a dose so that the suggested dose and actual dose are not equal all subsequent Induction dose calculations are prevented and a Calc prevented not following protocol warning is generated This is the case whether you modify a dose before they instruct the patient or retrospectively update the last dose to reflect what the patient actually took see Retrospectively Adjusting the Last Dose 2 During the Induction phase if you test a patient on a day other than the date suggested in the protocol all subsequent Induction dose calculations are prevented and a Calc prevented not following protocol warning is generated 3 Unlike Maintenance doses Induction doses can be calculated where 2014 202 Dawn Version 7 E Manual e The last instruction does not span 7 days e The last instruction co
144. aaa iaaii aaaea ya ando SEE 395 2 Detailed Non VKA nnn 395 Mualim A s ero yer get 397 ochedule an Iniaorn CHODE V tenen Pee ete xt e eve e nux ne vx get ven neenon 399 Complete an Iniation Questiontialkes ioi eo Davos koe ER EX A Dua docu b Ree Lee 400 m cs 401 Oualibving Fis aote ce aerea t udi teet beet Maat ai 401 Renal TUNC UON 402 INP AIRING Mo 403 Goriraimadic ated desse viver tco quist ie ad Spa ER cb kee fade Us 403 t gio cL 404 Other anticoagulant or platelet inhibitor nnns 405 WTC FINI LU IRURE 405 OUTER C ONT AINGIG AMONG RUM 405 IAG IIOMEMAGIC TIS 406 DOS Gracer M 407 GRA DS ang HA SBEE
145. able for UK Sites using the NHS Number Enforce NHS Number Compliance Mandatory Patient Identifier Important Note When you enforce NHS Compliance Validate amp Verify Only or Full Compliance DAWN makes the following changes e drop down list of verification states is displayed below the NHS Number The default status is either Number present but not traced Trace Required The NHS Number appears in the title of the Patient screen and on the patient search screen f your Mandatory Patient Identifier is set to Unit Number recommended the Unit Number also appears in the screen title On entry or edit The NHS Number is checked to ensure it is a valid NHS Number Invalid numbers are rejected The NHS Number is formatted in 3 3 4 format When searching for a patient e You can enter the NHS number with or without spaces PLEASE NOTE NHS numbers that are already in DAWN when you turn on NHS No compliance are only validated and formatted when you edit the number or change its verification status When you switch on Full compliance DAWN makes one additional change The NHS Number only appears in reports letters emails or outbound interface messages once you change the status to Number present and verified No Y 7 Read all the information on this page carefully before changing this setting Unit Number If you enforce NHS Number compliance we recommend you set the Unit Number as the Mandatory Patien
146. active treatment plan DAWN prompts you to stop their treatment plan first 2014 Stopping Treatment Deactivating or Marking a Patient as Deceased 19 3 Marking a patient as deceased If a patient dies you can mark them as deceased Marking a patient as deceased automatically stops any active or suspended admitted active admitted discharged or non attending Treatment Plans To mark a patient as deceased 1 From the main patient screen select the Personal Contact Info tab Graph History Personal p Questionnaires Test Results Contact Last name eee Age 45 Hobile phone Hosp No Work phone NHS D O O Email address Address 1 49 meadow view Fax number Address 2 w County Telephone Numbers Postcode items to display Sex Dateofbirth Tow E Ethnic origin MN Language None selected Status Active 2722722 2014 186 Dawn Version 7 E Manual 2 Press the Deceased button DAWN displays a message box prompting you to confirm you wish to deactivate the patient 3 Press OK to confirm The patient s status changes to deceased and the Deactivate button changes to Reactivate If the patient has any active or suspended admitted etc Treatment Plans DAWN automatically stops them first If a Treatment Plan requires a Cessation Heason when stopping DAWN searches for a cessation reason called by default Patient
147. actual date of the measurement if different either by over typing the current date or by clicking the calendar control and picking the date from the pop up calendar 19 DAWN AC only recognises weight measurements as valid for dose calculation if the date of measurement was recent The AC LMWH PatientWeightMeasurementExpiryIntervalDays system setting holds the number of days following the date of measurement that a weight is deemed valid The default setting is 14 days 20 If a weight measurement is older than the number of days specified in the LMWH PatientWeightMeasurementExpiryIntervalDays system setting DAWN AC does not calculate a dose and displays the following message box 2014 244 Dawn Version 7 E Manual Dosing Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 eR T x Sat Sun Wed Thu gt Sat Wed Thu Sun Mon Tue Wed Thu Dose 1 939 Y 79 Windows Internet Explorer Please measure Ehe weight of the patient and enter the current value The patient s weight was measured too long aga to use For calculating L wMH drug dose are no items to display are no items to display Mone selected HighRisk lbs Measured at 05 11 2007 BMI Height mch Measuredat BSA
148. ain the Regime The Regime status changes to In Maintenance and the workflow buttons change to Activate and Deactivate 2014 324 Dawn Version 7 E Manual 8 Once a Regime is In Maintenance none of its instructions can be used to dose a patient 25 4 2 7 4 Deactivating a Regime To deactivate an active regime 1 Choose Lookup Tables Anticoagulation Tables Regime from the System menu to display the list of existing dosing regimes 2 Select the Regime you wish to activate from the list and press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document Windows Internet Explorer T wWARNIMG You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these Eables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again to accept these terms and to edit the data 3 To accept these terms press OK and then press the Edit button again as directed in the message box The edit dosing regime form is displayed 2014 Ant
149. ain to actually clone the regime The regime is cloned and the cloned copy is displayed A message box 2014 Anticoagulants Dosing Regimes and Instructions warfarin 30 appears informing you that you are looking at the cloned version Status In Maintenance Anticoagulant Warfarin 000000000 Brand Generic Warfarin z Daily Weekly DoseUnits MinimumTabletPart ShowInstructionTotalDoseLine Tablet 1 Pills 6 mg Blue Green USA c Instruction record 1 50 70 Microsoft Internet Explorer 1 5 4 5 3 00 45 ms 6 00 r5 10 5 9 00 10 5 las 12 00 135 16 5 15 00 16 5 19 5 18 00 19 5 22 5 21 00 22 5 255 24 00 27 00 MaxinstructionDoselIncrement 2 Defaults for new instructions DayPattern susie nih D 00 0 0 0 0 Jmpart instr D Pd npr O DLE Pd part instr 2 JInpart O 7 You can clone an active regime without deactivating it or putting it into Maintenance When you do so the cloned version is automatically put into Maintenance so you can begin editing it straight away The original version remains active 8 The cloned regime has the same name as the original suffixed with clone For example warfarin 3 mg Daily Dose Clone 9 The cloned regime has the same code as the original suffixed with Clone For example WARS3D Clone 25 4 2 5 Changing or Inserting Additional Tablet Strengths into a Regime You may wish to clone an exi
150. aking tablets advised currently trying to fi Y Wied 08 07 2009 2 1 50 00 ve Sun Mon a Wed Thu Fri Y Fri26 06 2009 2 4 50 00 w gp ng Total mg G S sw sie ciel Sil 5 Fri 15 05 2008 2 6 20 00 vw T Just stopped 2 interacting drugs and INR dropping Raised Tue 14 04 2008 2 6 21 00 vw Wl Hose and will test again in one week Ved eJ4 20098 2 1 21 060 we Tue OF 042009 2 7 21 00 ve Ma Mon 06 04 2009 2 1 21 00 ve Wa 2014 250 Dawn Version 7 E Manual A Un uU m m ZU Dosing Drugs Events to INR 2 3 InRange Date 22 07 2009 Y eo Not scheduled j Foo mg Far 1 days then h Warfarin Sun Mon Tue Wed Thu Fri Sat warnings 15 15 1 15 14 15 1 Treatment notes gp Patient has stopped taking tablets as advised currently trying to Find out what patient is actually taking Dose decreased by 23 Dose 38 50 w Y Status Tested 12 08 2009 EE 3 wk Accept dose Dose Time DNA In range Comments N Y Wed 22 07 2008 2 3 38 50 wd 3 wk Patient has stopped taking tablets as advised currently trying to fi Y Wed 08 07 2009 24 50 00 wii 2 wk LA Wea 01 07 2008 2650004 FEAT IME Fats fort ep Y Fri 26062009 24 50 00 wg 6 wk Y 15 05 2009 2 6 20 00 wif eu Warfarin Sun Mon Tue wed Thu Tue 14 04 2008 2 6 21 00 vw 4
151. all the Low Molecular Weight Heparin preparations included You may also wish to change the display name the name that appears on the dosing instruction For example UK patients may know Enoxaparin as Clexane while US patients may know it as Lovenox To hide a tablet record 1 Press F5 to display the system menu 2014 we Dawn Version 7 E Manual 2 Choose Look Up Tables Anticoagulation Tables Anticoagulant to display the Anticoagulant list 3 Choose warfarin from the list of Anticoagulants and click the first tablet in the list of tablets to show editable tablet list 2014 Anticoagulants Dosing Regimes and Instructions warfarin AnticoagulantTablet Warfarin Sorting ByRegion Bv5ize 4 CR Search for Caption AltTexk Barr USA Warfarin Tabletsize Caption AtText Notes Image amp img EO Jees amp __ em e amp sm mn Coumadin USA Coumadin Tabletsize Caption Alten Notes Ins Image _ 3 1 00 Pills 1 mg Pink zo pismg lavender 250 0 sm pisGmg 0 1 A GC og amp amp m 00 Pils 10 ma Cau CE 4 Deselect the InUse checkbox for any tablet you do not wish to use 5 Us
152. an instruction This defaults to Half a Tablet but can be changed to Whole Tablet or Quarter of a Tablet 2014 Anticoagulants Dosing Regimes and Instructions warfarin When defining instructions for a regime or customising a dosing instruction for a patient DAWN AC prevents you entering a dose that cannot be achieved in multiples of the smallest tablet part of the smallest tablet size Regime WARFARIN B WEEKLY DOSE Weekly Active WARFARIN 7 5 WEEKLY DOSE Weekly Vartarin Induction in Daily Avg Daily Active WARFARIN MIXED TABLETS WEEKLY Weekly Active Vartarin Plain Text Regime Daily Active E E vuarfrin neve regime Daily Mew Status New 77272272330 Anticoagulant Warfarin Brand USA Warfarin Daily Weekly DoseUnits MinimumrTabletPart ShowInstructionTotalDoseLine Tablet 1 Pils 1 mg Pink Taro USA Tablet 2 Pills 3 mg Tan Taro 05 Tablet 3 Pills 5 mg Peach Taro usa x 1 Instruction here are no items to display MaxInstructionDoseIncrement 1 5 Defaults for new instructions DayPattern 2222 Inpart inst instr Clone Regime DB C 2 The Max Step Between Instructions defaults to the Miniumum Tablet Part of the smallest tablet strength but you must choose whether instructions increment by this amount per Week or per Day A
153. and can be included in management research and clinical audit reports To Deactivate a patient 2014 14 Dawn Version 7 E Manual 1 From the main patient screen select the Personal Contact Info tab O_O c M n Graph History Personal Treatment plans Questionnaires Test Results Lastname fal Firstname Home phone ME Hobile phone Hosp No X213344 Work phone NH5 No Email address Address 1 49 meadow view Fax number Address2 Messaging method Phone pref written by mail Town additonal OOOO O O County Dublin Telephone Numbers Postcode ere no items to display Sex Mae v Title Dateofbirth DoD Ethnic origin None selected Language nnum Status 2 Press the Deactivate button DAWN displays a message box prompting you to confirm you wish to deactivate the patient 3 Press OK to confirm The patient s status changes to nactive and the Deactivate button changes to Reactivate If at a later date the patient starts a new course of therapy press the Reactivate button to reactivate their record before creating a new treatment plan You cannot deactivate a patient without first stopping any active treatment plan active in this sense also includes Suspended admitted active admitted discharged and warnine NON attending statuses If you attempt to deactivate a patient with an
154. and dose For example you have chosen 75mg once per day for Dabigatran in an AF patient If this regime is not permitted it will be possible to complete an Initiation Questionnaire wth this combination and a treatment plan cannot be activated and a follow up cannot be scheduled 8 DAWN AC performs 2 checks on every primary diagnosis Firstly the drug and diagnosis must be stored in your Look Up Tables as a Therapeutic indication like Dabigatran being acceptable as an anticoagulant in Atrial Fibrillation non valvular Secondly DAWN AC stores Permitted Regimes for each diagnosis So several doses such as 150mg twice daily or 110mg twce daily may be acceptable but 75mg once per day may not be acceptable for Dabigatran in Atrial Fibrillation non valvular e the drug chosen is not a non VKA anticoagulant For example you may have chosen Warfarin mixed tablets regime and marked the treatment plan as non VKA in the target range box 2014 New Oral Anticoagulants non VKA Section You have selected a Mon Vitamin K Antagonist Target Range for an anticoagulant that is a Vitamin K Antagonist e the appropriate questionnaire has been completed BEFORE the treatment plan is activated For example you may select a treatment plan for Dabigatran 150mg twce daily but forget to through the list of possible contraindications interactions risks DAWN AC will prevent activation of the treatment plan and sche
155. and is also used to restrict the tablets you can choose for the regime to those for the particular brand This prevents you from inadvertently selecting a UK 1mg tablet and a Coumadin 5mg tablet in the same regime 9 Select the DoseUnits in which the instructions for this regime are to be expressed mg Instructions show the number of mg the patient should take on each day Tablets Instructions show the number of tablets of a single strength which the patient should take each day Mixed Tablets Instructions include lines for up to three different tablet strengths each showing the number of tablets of that strength the patient should take each day Mixed tablet regimes can optionally shown an additional Total mg line INR 2 4 InRange 7 Date 07 04 2008 Y Sun Tue Wed Thu 5 Instruction in mg Brand UK generic INR 2 1InRange Y Date 07 04 2008 Y Sun Tue Wed Thu Fri Sat J 2 2 5 6 6 6 6 5 6 Instruction in Tablets Brand UK generic 2014 280 Dawn Version 7 E Manual INR 2 4 Low Y Date 21 02 2008 Y Tue Wed Thu Fri pt ddd Instruction in Mixed Tablets Brand USA Coumadin Depending on which of the settings you choose for DoseUnits you need to select further options as described in the following sections Creating a Regime expressed in mg Creating a Regime expressed in single strength tablets Creating a Regime expressed in mixed strength tablets 25 4 2
156. apy DAWN will force you to manually dose the patient Once the patient is stable once again you can then change the therapy back over to maintenance You can start a patient on manual bridging therapy by selecting the options shown below when you create or edit their treatment plan Disease area Anticoagulation ACTherapy t Induction PrimaryDiagnasis Mane selected Manual Bridaing Maintenance therapy can be f Manual Bridging ETE 08 04 2010 First seen date chosen from these Duration type radio button options Mane selected Regime Mane selected m Preferred clinic Mane selected E Induction algorithm Mane selected m Preferred time From ms until Sample instruction Status MaxPercentDoseChange MaxInterval ProblemPatientFlag time in range CZN Date of referral sl When you enter an INR for a patient on manual bridging therapy DAWN will not suggest a dose and next test interval and a message appears within the Warnings box to inform you that this patient is on bridging 2014 224 Dawn Version 7 E Manual Scheduled For Thu 08 04 2010 09 00 11 00 in clinic CLINT DOM 2 Status Tested Accept dose 2014 2 Dawn Version 7 E Manual 25 25 1 Anticoagulants Dosing Regimes and Instructions warfarin Dosing Regimes Basic Concepts The regime within DAWN AC holds the choice of anticoagulant and tabl
157. at In part instr ined 1 15 1 In part instr DOS Inpartinstr 7 4 In part instr JayPattern Sun Tue Wed Thu ia 1 1 Here the selected instruction has an upper limit of 1 4 while the next instruction up has a lower limit of 1 46 DAWN AC selects a dose instruction using the following criteria numeric dose gt lower limit and lt upper limit aS Such in this example no instruction exists for numeric doses between 1 4 and 1 46 This particular problem may be due to one of two causes Cause 1 2014 Anticoagulants Dosing Regimes and Instructions warfarin 315 e There is a genuine missing instruction In other words the instructions increment following a regular pattern but one step has been inadvertently missed out For example a dosing regime steps up using the minimal increments pattern described in the section Regimes and Instructions Tips on Creating Dosing Instructions Creating Dosing Instructions The instructions increment in 1 mg per week steps so the instructions for average daily doses between 1mg and 1 mg should be d E 30 55 Dose Limit Limit 429 _ 11258 1325 amp 1483 139 1465 _ gt a um NS lt 1 4 1 395 1 465 150 1456 1535 _ The total dose achieved over a week increases by mg with
158. atient p o a 9 m Um Dosing INR 2 5 InRange Date 15 03 2010 Y wo Mot scheduled DENEN Warfarin Mon Tue wed Thu Fri Sak Sun Total M Ma dose change Dose d Status Tested 2910312010 z wk Accept dose f DAWN is unable to suggest a dose or next test interval then you will need to manually enter these for a patient There are several reasons why DAWN may be unable to suggest a dose or next test interval here is no previous dosing history to base a dose calculation on he last test was more than the maximum number of days allowed within the DAWN system settings The INR is very high or very low less than 1 3 or bigger than 5 within the DAWN standard dose settings he treatment plan start date is less than 7 days old Interval from last test is less than 7 days Interval between the previous two tests is less than 7 days he last treatment record was dosed using bridging therapy see Bridging Dosing section 2014 Managing Patients Under Different Therapies 223 You can choose to overwrite the suggested dose and next test intervals at any time for a patient See Dosing an Anticoagulation Patient for more details 24 3 Manual Bridging Dosing Manual Bridging therapy is used whenever the patient is in a period of instability such as when you are stopping and restarting warfarin for a surgical procedure While a patient is on manual bridging ther
159. ation has already loaded all its system settings by this point it is necessary to unload and reload the application to pick up the new Style Sheet settings To unload and reload your application 2014 Dawn Version 7 E Manual 1 Ensure all users are logged out 2 Type the following URL into the address box of your web browser http DAW NServer DAW NAC Unloadnow asp where hittp DAW NServer DAW NAC or http DAWNServer DAWNAC Index html is the address you use to open DAWN AC Press Go A page appears saying Application Unloaded Please note the UnloadNow asp script is trying to unload itself from memory In other words it is effectively trying to pull the rug from under itself so it may not succeed the first time If you experience any of the following e It is taking a long time to run e You get a Website Page Not Found error e You get a Remote Procedure call failed to Execute error Simply try again by clicking Go or placing your cursor at the end of the address and hitting the enter key Repeat until the Application Unloaded page appears http fhpdesktop1 DawnAc UnloadNow asp Windows Internet o httpiihpdeskkopi JDaenaciLinloadNow asp File gt Links Customize Links 1 5 CRM http localhost Dawnac AT abr hpdesktopt DawnAc UnloadNow asp Application Unloaded Restart 4 Click the ReStart hyperlink and lo
160. ay in Female 14 mg per day INR Between Last Dose Dose Miss Days Interval Day 1 0 0 1 3 0 00 2 00 0 14 15 1 0 1 1 2 00 5 00 0 7 15 1 2 1 3 2 00 4 00 0 7 15 1 4 1 9 2 00 3 00 0 7 15 2 0 3 0 2 00 2 00 0 7 2014 220 Dawn Version 7 E Manual 15 3 1 4 0 2 00 1 00 00 5 Oates Et AI Male Sex Dose by Day in Male 14 mg per day INR Between Last Dose Dose Miss Days Interval Day 1 0 0 1 3 0 00 2 00 0 14 15 1 0 1 0 2 00 6 00 0 7 15 1 1 1 2 2 00 5 00 0 7 15 1 3 1 5 2 00 4 00 0 7 15 1 6 21 2 00 3 00 0 7 15 2 2 3 0 2 00 2 00 0 7 15 3 1 4 0 2 00 1 00 0 7 6 Tait Et Allnduction Sex Dose by Day in Both 8 mg per day INR Between Last Dose Dose Miss Days Interval Day 1 0 0 1 3 0 00 5 00 0 4 5 0 0 1 7 5 00 5 00 0 3 5 1 8 2 2 5 00 4 00 0 3 5 2 3 2 7 5 00 3 00 0 3 5 2 8 3 2 5 00 2 00 0 3 5 3 9 3 7 5 00 1 00 0 3 D 3 8 5 0 5 00 0 00 0 3 8 0 0 1 7 1 00 2 00 0 7 8 0 0 1 7 2 00 3 00 0 7 8 0 0 1 7 3 00 4 00 0 7 8 0 0 1 7 4 00 5 00 0 7 2014 Managing Patients Under Different Therapies 221 8 0 0 1 7 5 00 6 00 0 8 0 0 1 9 0 00 1 50 00 4 8 1 8 2 4 1 00 15 00 8 1 8 2 4 2 00 2 50 0 8 1 8 2 4 3 00 3 50 0 8 1 8 2 4 4 00 4 00 0 8 1 8 2 4 5 00 9 00 0 8 2 0 2 9 0 00 1 00 0 4 8 2 5 3 0 1 00 1 00 00 8 2 5 3 0 2 00 2 00 0 8 2 5 3 0 3 00 3 00 0 8 2 5 3 0 4 00 3 50 0 8 2 5 3 0 5 00 4 00 0 8 3 0 3 5 0 00 05 0 4 8 3 1 3 5 1 0
161. b may not be appropriate for types of Regime See the section Creating a Dosing Regime Setting the Max Step Between Instructions for full details on how to set the Max Step Instruction Settings correctly Please note if this setting is inappropriate DAWN AC may think your regime is missing dosing instructions and prevent you from activating it See the section Activating Deactivating and Maintaining Regimes Activating a Regime Validation Checks Missing Instructions for further details 2014 286 Dawn Version 7 E Manual 7 See the section Setting Defaults for New Instructions for advice on filling out the Defaults for New Instructions fields 8 Please note Miss and Boost Days are expressed in Tablets if the patient s regime is expressed in single strength Tablets for example Take 0 00 Tablets for 2 days Take 3 00 Tablets for 1 day 25 4 2 1 3 Creating a Regime Expressed in Mixed Strength Tablets 1 Follow the instructions in the preceding section Creating a Dosing Regime to create a new regime and set the general settings 2 Choose Mixed Tablets from the drop down list of DoseUnits options to create a regime expressed in mixed strength tablets 3 Choose the tablet sizes you wish to include in the regime from the drop down lists against each of the three tablet options take care care to select them in ascending order Tablet 1 omallest Tablet Strength Tablet 2 Middle Tablet Strength Tablet 3 Largest Table
162. bles Organisation Then select or search for the required Organisation And click on the View Details icon 2014 Setting up Printing User Guide 16 2014 e On the Organisation details screen select the Location tab Organisation OrganisationType Laboratory m Mame Hospital NM _ a m h i M Location Pri n e Nurse Station Reception e Click on the Insert A Record icon to display the New Record screen e Enter a name for the new printing location and click OK The Organisation Location tab will be displayed again e Click on the name of the new location to re display its details e Click on the Insert A Record icon next to the Printers in this location field to display a list of available printers 166 Dawn Version 7 E Manual Please select Printer For Ehe kable PrinterLocation You can select more than one ikem W sdel Colour Paper 44 W sdc1 HP Business Inkjet 1200 Series Paper 44 W sdcl HP CLJ2820 PCL 6 Black white Paper 44 W sdclhp LaserJet 1320 PCL 6 Paper 44 e Select the required printer and click OK or select multiple printers by holding down the shift key while clicking to return to the printing location screen InUse Printers in this location 4 4 e Micrazaft XPS Document
163. c records x 7 Choose Regimes from the Tables to import drop down list to display the 3 default Induction Regimes 2014 Polar DataExchange E j 20 Dawn Version 7 E Manual Uploaded file 5 CF vzYDasing Regimes TESTED DOSING REGIMES v7 721MEW 1mg 5mg Warfarin Weekly in xml Default import policy created at 27 02 2009 12 58 created by Dawn Dawni Dawn Select another file Import Selected records x Required records x Automatic records lt Table to import Fe 0 Mot selected For import Selected For import NEW Warfarin 1 amp Smg Tablets Weekly with Halves inport policy For table Regime Import Update existing Selected records K E Required records E Automatic records Perform import updates 8 Use the appropriate button to move the regimes you require into the Selected for import list you can hide the ones you do not need later 2014 Anticoagulants Dosing Regimes and Instructions warfarin 261 Uploaded file F SUPPORTA CF v71Dosing Regimes TESTED DOSING REGIMES 7 72 NEW 1mg Warfarin Weekly in TABS xml Default imparE palicy created at 27 02 2009 12 58 Import created by Dawn Dawni Dawn Selected records x Select another file Required records x Automatic records Table to import Mot selected For import Selected For import NEW Warfarin 1 amp Smg Tablets Weekly with Halves Moves
164. cal to how your DAWN AC system operates and any changes deletions additions are likely to affect the anticoagulant dosing of past present or future patients ALL changes to settings should be tested thoroughly on a test database before applying changes in your production database AD Permitted Regimes Other validation checks are made on first activation of a treatment plan and on saving an Initiation Questionnaire on the settings stating which regimes ie dose of Dabigatran for example are appropriate for which primary diagnosis or therapeutic indication Additional regimes can be added to this table as appropriate Permitted Regimes LITTERE 7777 Y c Dabigatran AFNR Atrial fibrillation nonvalvular Dabigatran 150 mg twice daily Normal dose BR Dabigatran Atrial fibrillation nonvalvular Dabigatran 110 mg twice daily Patients aged i c Dabigatran AFNR Atrial fibrillation nonvalvular Dabigatran 220mg once daily The Clinical Advice is displayed on the Initiation Questionnaire screen as below and the Order number is relevant for display on the questionnaire screen V alid dosing regimes for this indication are Dosing regime Advice Dabigatran 150 mg twice daily Normal dose Dabigatran 110 mq twice daily Patients aged 80 or over or at risk of bleeding Dabigatran 220mg once daily NB deletion of an entry for Permitted Regimes may result in multiple patients not getting
165. cant risk of bleeding The user chooses the dose from a drop down menu Dabigatran Dose None selected None selected Dabigatran 150 mg twice daily Dabigatran 110 mg twice daily Dabigatran 220 mg once daily Da inh 150 mg once T 2014 Dawn Version 7 E Manual 27 1 4 5 The dose is assigned for each patient using the Initiation Questionnaire and this links to the patient s treatment plan which must have the dose and Primary Diagnosis set as indicated in the questionnaire If there is a discrepancy in the information entered for your patient a warning is displayed on screen A This dose ts not appropriate for this therapeutic indication The settings for dose options may be updated as new medical evidence emerges using the Look Up Tables in DAWN AC back to Help page Overview of Validation Checks Activation of a new treatment plan for on DAWN AC triggers some background checks as follows If the user selects activate and all checks pass the treatment plan is activated without error If there is any discrepancy an error message will indicate the problem and the user may correct the Initiation Questionnaire or the treatment plan or both and activate again Should your DAWN AC settings need to be updated as new medical evidence emerges please contact your system administrator Checks for non VKA treatment plans e the primary diagnosis is one known to be acceptable for the chosen drug
166. ch the Selected Brand oee the following sections for a full explanation of each and tips on how to resolve them 2014 Anticoagulants Dosing Regimes and Instructions warfarin 313 DAWN checks no two instructions have the same Avg or Total Dose If it finds two or more instructions with the same Avg or Total dose it displays the following message Windows Internet Explorer Solution Locate the instructions with the same Avg or Total dose and delete the one you do not wish to keep LowerLimit UpperLimit Avg dose 1 4 Line 1 Sun Mon Tue Wed Thu Fri Sat In part instr Line2 15 1 15 1M 1k In part instr Line3 In part instr Pd sail Pi part instr HH px DayPattern Sun Mon ita ia 1 ita 102 DAWN checks for missing instructions If it finds one or more missing instructions it displays the following message 2014 aia Dawn Version 7 E Manual Windows Internet Explorer T The interval between some instructions is larger than the max allowed interval of 0 08 Please 1 Check vaur Max Step Between Instruction settings are correct 2 Add missing instructions Jo then Activate this Regime again A Missing Instruction is detected where the the upper limit of one instruction does not equal the lower limit of the next instruction up as in the following example owerLimit 1 325 JpperLimit Avg dose inel Sun Hon Tue Wed Thu Fri S
167. click on Events tab to fully record events on the patient screen back to Complete a Follow up page 27 2 3 2 4 Renal function Estimates of renal function may be recorded in several ways on the Follow Up Questionnaire 2014 42 Dawn Version 7 E Manual and these will show contraindications warnings for Dabigatran where renal function is impaired e measured creatinine clearance laboratory estimation e Serum creatinine e Cockcroft Gault estimation of creatinine clearance e other measures may be recorded in the notes box Guidelines recommend using an estimate of creatinine clearance rather than an eGFR calculation when dealing with patients on Dabigatran anticoagulation DAWN AC provides a calculator for estimating renal function from serum creatinine and body weight Enter these 2 values and click on the Calculate Cockcroft Gault CrCL Measured Creatinine Clearance Cockcroft Gault estimate of CrCI Cockcroft D Gault MD Nephron 16 31 41 1976 Serum Creatinine Body Weight mL min 188 umovVL High 69 kg er Female TU 2f mL min Please be aware of the limitations of estimates of renal function in relation to muscle mass race and diet 1 23 x 140 age years x weight kg x 0 85 if female serum creatinine pmol L x Contraindicated severe renal impairment Note if you have a laboratory estimation which if less than a numeric value like lt 30 please enter the number like 3
168. compliance problems Yes No U Yes No Yes Wo f Yes No effect 0 Please tick any of the compliance problems which apply to your patient These problems may be important in dosing decisions for Dabigatran 2014 New Oral Anticoagulants non VKA Section Reasons for compliance problems Cost Dementia Fear of side effects Gastroesophageal Reflux Disease Gastrointestinal Bleed Lack of information Lives alone Multiple medications Prescriptions from several doctors The list of compliance problems may be edited added to by your system administrator using the General Look Up Category Table called ComplianceReason back to Complete a Follow up page 27 2 3 2 3 Adverse events reported Please tick any of the adverse events which apply to your patient These events are identified in prescribing guidelines as significant events for consideration in dosing decisions for Dabigatran Has the patient reported any adverse event potentially due to current anticaagulant Anaemia Bruising Change in color of stools Epistaxis Haematoma Vomiting blood The list of adverse events be edited added to by your system administrator using the General Look Up Category Table called Adverse Bleed Events NB any events identified on the Follow up Questionnaire will NOT automatically display on the Events tab of your patient screen Please
169. confirm whether the preceding 9 digits comprise a valid NHS number using a modulus 11 algorithm When you switch on compliance DAWN automatically applies these validation checks whenever you enter or amend an NHS number The system does not allow you to save an invalid number Format The number can be entered with or without spaces but is reformatted when saved to ensure it is always stored displayed and output in 3 3 4 format e g 012 345 6789 Verificati Verification is the process of using the NHS tracing service to verify that a on given NHS number is the correct number for a particular patient You cannot 2014 Enforcing Mandatory Use of the NHS Number 45 trace a number directly from DAWN it is envisaged that you will do this through your central Patient Administration System However you must record the verification status of each patient s NHS number in DAWN There are 8 possible statuses 01 Number present and verified 02 Number present but not traced 03 Trace required 04 Trace attempted no single match 05 Trace needs to be resolved 06 Trace in progress 07 Number not present and trace not required 08 Trace postponed baby 6 weeks old By default DAWN sets the NHS number verification status to 02 Number present and not traced where the DAWN patient record has an entry for NHS number and 03 Trace required where it does not Providing you have the appropriate User Profile permissi
170. cted records x E Required records Automatic records Perform import update 11 Select MessageTemplate from the Table to Import list and move all the records into the selected for import list 2014 Anticoagulants Dosing Regimes and Instructions warfarin 345 Polar DataExchange Uploaded file F DE Clinical v7 8 11 Default LMWH Tablets Brands DataExchange xml Default impart policy created at 01 02 2008 13 55 Import Update existing created by Support 45 Dawn Selected records x Required records x 0 Automatic records Table to import Not selected For import Selected For import Dosing Instruction examples HTMLDosingInstruction Style Sheet Settings TJ import policy For table MessageTemplate Import Update existing Selected records x Required records fokomatir records 12 Press Perform import updates to import the records 13 Perform each of the checks described at the top of this section to see if you have any Brand Tablet and LMWH records This time each list is populated with DAWN default entries 14 Follow the instructions in the next section to hide any unused tablets and LMWH records 25 6 3 Hiding Unused Tablet Strengths Depending on where you are based not all the makes and strengths of warfarin tablet supplied as defaults will be relevant to you Likewise you may not use
171. ction in milligrams 295 E Day Pattern Instruction in Multi Strength 297 Day Pattern Instruction in Single Strength 297 Day Pattern Instructions Compatibility 265 H Decrease 193 decrease dose 412 haemorrhagic risks 426 delete a questionnaire 400 418 HASBLED 408 427 diagnosis 374 HCProfessional different 191 Adding 70 different VKA s 430 Editing 70 DNA 434 Health Authority DNA Count 211 Adding 49 Dose Calculations Editing 49 Preventing 251 Health Authority Form 50 Dose History 249 Healthcare Account Information 74 Dose Instructions in Mg 237 Healthcare Professional Form 73 Dosing a Patient 188 Healthcare Professional Password 75 Dosing Instruction Tips 325 Help with recommended guidelines 388 Dosing Instruction Types 227 hepatic 423 Dosing Instructions Hiding Unused Tablets 345 Working With 228 Highlight 200 Dosing Regime Creating 277 a Dosing Regimes Activating 309 Import 158 Basic Concepts 226 Importing Default Tablets 340 Deactivating 309 Increase 194 Maintaining 509 increase dose 412 dosing warnings 391 Induction 214 Induction Dosing 255 Induction Dosing Validation 261 Initiation 378 Edit Dose Instruction 230 INR 188 Editing Existing User Profiles 64 Instruction in Message Templates 262 Export 157 interacting drugs 424 Interface Results Interface 151 Frequently Asked Questions 363 First Day 233 lato 434 Follow up 383 Leave Days 235 follow up questionnaire 415 List of Blood Groups 100 Front
172. d enter the amount per kg e g 1 If you enter an absolute dose this dose is entered by default for a patient when you select this drug from the LMWH selection list If you enter a dose per kg the patient s dose is calculated from their weight so long as their weight has been entered and the date their weight was measured is within the valid interval defined in the System Setting Leave the dose field blank if you do not wish any dose to be entered by default for a patient when you select this drug from the LMWH selection list 7 f the dose can vary between patients use the Min and Max Dose fields to define upper and lower valid limits for a patient s dose If the dose is per kg enter a Min and Max Dose per kg When entering or modifying a LMWH dose for a patient DAWN only permits you to enter doses that fall within this range When defining these limits allow sufficient headroom for rounding the dose to the nearest pre filled syringe size if appropriate For example if a patient weighs 70 kg and the dose is 1mg per kg the patient s theoretical dose is 70mg However if the nearest pre filled syringe size is 80 mg it is necessary to prescribe 80 mg instead which works out as 1 14mg per kg Establish the actual dose per kg represented by your largest likely dose rounding and set the Max dose and Min doses accordingly e g 0 8 and 1 2 mg per kg 2014 Anticoagulants Dosing Regimes and Instructions warfarin 331 Min
173. d frequency default according to the settings for the regime you select 24 If you select an automatic regime where the dose and frequency settings are predetermined see Setting up LMWH and Pentasaccharide Agents the dose and frequency are set automatically according to the Regime settings and cannot be edited manually 25 If you select a manual regime no dose is set by default You set the dose and frequency manually 2014 me Dawn Version 7 E Manual Customize dosing instruction mumadin Mon Tue Wed Thu 6 Mon Tue Wed Thu LoVe 60 v DMa 25 3 7 Validation of LMWH doses 1 If the LMWH drug has a min and max dose defined see Setting Up LMWH and Pentasaccharide agents the system checks that the dose you have specified falls within these limits 2 If the dose falls outside these limits a warning message is displayed when you try to close the Customise Dosing Instruction form When you OK the message you are returned to the Customise Dosing Instruction form You must change the dose to a valid amount before you can close the Customise Dosing Instruction form or save the record 2014 2014 Anticoagulants Dosing Regimes and Instructions warfarin Dosing INR 2 4 InRange Date 22 07 2009 Y Teen Sun Wed i E Total mo Eri ame x E s Sat mr Sun Mon TE P m Fn m Seer eee ee
174. d in the regime See Setting Up Regimes and Instructions Regimes and Instructions Creating a Dosing Regime for an explanation of the Minimum tablet part C OOO Date IHR Dose Wed 18 08 2008 0 0 0 00 ve Y Wed 1203 2009 2 4 44 00 vw amp PR Y Wed 22 07 2009 2 3 44 00 w Y Wed 08 07 2009 21 50 00 w gy Wed 01 07 2008 2 6 50 00 w gy Y Fri 26062009 2 4 50 00 w gy Frid D5 2008 2 6 20 00 w gy Tue 14 04 2009 2 6 21 00 ve ifl Wed 0804 2009 2 1 21 00 w gy Tue 07 04 2009 2 7 21 00 w ifl 4 If a Treatment record has been edited to record the actual dose the patient took instead of the dose they were supposed to take see Working with Dosing Instructions Retrospectively Adjusting the Last Dose the treatment record displays the adjusted dose and a blue exclamation mark is displayed beside it date HR Dose Time Inrange Comments Wed 2309 2009 0 00 di T Wied 02092009 28 271 dil 3 wk Y Weed 260872009 23 Actual dose the patient took Y Wed 1908 2009 21 300 dif Y Wed 12 06 2009 28 3 00 dii the patient was supposed to Wed 72 07 2009 341 3 00 dif Warlarin Sun Mon Wei ILI ri Y Wed 01 07 2008 24 3 00 dig 4 3 3 3 Y Fri 19106 2009 24 21 00 vv di 2 wk 3 patient feeling dizzy Wed 1045 2008 21 21 00 vv di 4 wel 1 _ 18 05 2009 24 21 00 vv di B wk CRITICAL CASE LEFT MESSAGE Tue 14042009 24 21 00 vv di _
175. date is displayed on the Dosing tab then you will need to firstly click on the next appointment record on the History tab 2014 Dawn Version 7 E Manual Dosing Contacts Letters Drugs Events Procedures T Reviews Reminders Groups Mot scheduled Schedule manually m Treatment notes dose zero Status Scheduled Accept iR Dna Un schedu O LL Graph History mal Wed 07 10 2009 c Tue 06 10 2009 2 3 4504 zwk Tue 29 09 2009 24 5 00d id 2 mE Thui7 09 2009 2 1 7d You will be taken to the treatments screen for the patient Click on the Unschedule button for this visit 2014 Frequently Asked Anticoagulation Questions 365 ERROR The regime is currently not Active It cannot be used ERROR The regime is currently not Active It cannot be used ERROR The regime is currently not Active It cannot be used 1111111 PILLS 3 SIZE PER DAY ACTherapy Maintenance NonAttendanceCount SeeDrFlag L SeenDrFlag Sample No fF InPatient LI ContactStatus HoRequremenk wv AutoAuthorisationR esult Now an orange Delete button will appear at the bottom of the screen Click on this and say OK to the pop up message asking whether you are sure you wish to delete the record The authorised treatment record will now appear on the treatments screen Click on the backwards facing arrow to undo this record
176. dding Slot Templates Clinic ApplicationAres Organisation 7577 77 Description Anticoagulation 45 Dawn Clinical Software Anticoagulation Clinic x Anticoagulation Big Hospital Moorside Clinic ApplicationArea Anticoagulation Description Moorside Clinic Organisation Big Hospital Locolode 71 x MT as tients Y eate Delete Diary 2014 Dawn Version 7 E Manual 9 11 4 New Slot Template Form ClinicSlotTemplate Moorside Clinic Big Hospital New record SktarktTime EndTime cap Reserved cap a Sun Mion Tue Wed Thu Fri Sat akk 2014 Settings for DAWN AC 9 11 5 Saved Slot Template Form LII P sn R Organisation Description Anticoagulation 435 Dawn Clinical Software Anticoagulation Clinic x Anticoagulation Big Hospital Moorside Clinic x Sif Templates Adjustments Create Delete Diary EndTime Max cap Reserved cap intereat Sun Mon Tue Wed Thu Fri Sat amp 0900 i700 2 1 10 mintes O B El i x 2014 Dawn Version 7 E Manual 9 11 6 Clinic Adjustment Form Description Public Holiday startDate 51 06 2009 ao EndDate SEark Time EndTime
177. definibe However if the patient is only attending another clinic as a one off visit then you can do this by just following the steps below On the patient s dosing tab there is a Reschedule Manually link Click on this Dosing Letters Drugs Events Procedures Reminders Groups Documents Owners Account Aud IL E Scheduled For Mon 02 1 112006 Ls a manualy 73 edule 4 dose zero Dose 0 00 d Status Scheduled Mext This will take you to a clinic diary screen From here you have the option to change the clinic for the next appointment Once you have picked the new clinic click on the date box and this will present you with some times to choose from Choose the Select button to pick the clinic slot you need 2014 Frequently Asked Anticoagulation Questions 369 elect an appointment for Phillips Lindsey Recommended date Fri 30 10 2009 Clinic Diary date Sun 01 11 2009 PICKS Tue Wed 1 2009 LL 1 2009 FriD5 11 2009 Sat ert 1 209 lt 35 18 36 18 35 18 36 18 35 18 gt 2 days c34days 0 4 days 5 days 6 days 7 days 48 days Diary for Mon 02 11 2009 m The patient s screen will now be updated with the new appointment details Dosing Letters Drugs Events Procedures Reminders Documents iind xp AR 26 4 Managing Maintenance Induction
178. displayed Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 x Wed Thu Sat Sun Mon Tue m Sun Tue met Sun ad Iw 08 00 34 21 007 34 Status Tested 17 Either enter the dose manually or update the patient s weight and press Enter or Save The dose is calculated from the new weight 2014 Anticoagulants Dosing Regimes and Instructions warfarin oma Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y fees ER e ux Sun Mon Tue T Mon EE Fir Sun Wed T Sun Mon Tue TA LMWH 12h single amount Dose 1 93d Y Patient s weight 58 1 kg 128 0 lbs Measured 20 11 2007 Status Tested Next El Graph History Personal Treatment plans Ad Hoc Questionnaires Contact info Next ofkin Clinical Diagnoses a DVT NOT SPECIFIED 02 04 2007 Allergies are items to display Risks are no items to display BloodGroup None selected HighRisk L Weight ls Measured at 20 11 2007 E BMI Height Measuredat 88 BSA 18 When you enter the weight the Measured at date defaults to today Change the date to the
179. dose change Dose 50 00 w 24h single amount 5 Status DoseSet 12 Windows Internet Explorer mm Wed 22 07 2008 Y Wed 0820722009 Wed 01 07 2009 odays Y Fri 26 06 2009 Y Fri 15 05 2009 25 20 00 i B wk 4 E 14 04 2009 26 21 00 wa Wed 08 04 2009 21 2100 wif 07 04 2009 27 21 00 wa Mon 06 04 2009 2 1 21 00 vv d 3 If the LMWH Drug is weight based the Min and Max doses are defined as a Min dose per kg and a Max dose per kg In this case the actual Min and Max dose permitted is calculated for each patient based on their weight 4 If the LMWH Drug is not weight based the Min and Max doses constitute absolute limits which apply to all patients 5 If Min and or Max doses have not been defined no lower and or upper limit is enforced on the patient s dose 6 If LMWH Drug Regimes have been defined for the drug the Max and Min amounts defined for the particular Regime are used 7 f syringe sizes have been defined for the drug the dose is rounded to the nearest syringe Size so ensure max and min limits are wide enough to accomodate this rounding 8 If the drug is prescribed in 24 hour doses but you use the 24 hour two amounts option to specify a half dose for a certain day such as the day before the patient undergoes a 248 Dawn Version 7 E Manual procedure ensure the lower limit is sufficiently low to permit a
180. duling any follow up until the questionnaire is completed 8 The requirement for a questionnaire is set in the Look Up Table called Questionnaire settings and may be updated by your system administrator to add any required questionnaires for particular drugs e the completed questionnaire has different details from the treatment plan For example you may select a treatment plan for Dabigatran 110mg twce daily on the Initiation Questionnaire but choose Dabigatran 150mg twice daily on the treatment plan You have selected a regime for 110 mq twice daily but the Initiation Questionnaire records the intended dose as 150 mg twice daily Please correct the regime or amend the recommendation in the initiation questionnaire and include a comment to say why you are changing it back to Help page back to Settings for Regime and Dose Settings page 27 1 5 Reporting on the non VKA patient database The powerful SQL reporting tools in DAWN AC can be configured to extract counts or lists of patients on certain anticoagulants These reports may be used to assess recorded events in relation to the anticoagulant used Example 1 Patient count by range diagnosis and duration section 5 5 1 Example 2 Events all areas section 5 5 2 click here to go back to Overview page 2014 394 Dawn Version 7 E Manual 27 1 5 1 Example 1 Report NPSA 7 8 Patient Cnt By Range Diag and Duration r 11111 Diag nosis AF CARDI
181. e Trevor 7324234234 None Scheduled Overdue Sche Questionnaire Status White Walter 23124234 02 07 2012 Dabigatran Follow Up Overdue disce Morecambe 9876542 31 08 2012Dabigatran Initiation Overdue patient Scheduled Questionnaire Status summary 5 enson Hedley 123456 05 0 5 20 12Dabigatran Follow Up Scheduled Scheduled Brewster Bobbie 34523523542354 0 1 10 20 12Dabiga tran Follow Up Scheduled Scheduled Complete Hame mit Ho typically start a twice daily dose White Walter 23124234 which should be reduced to a once daily dose not recorded Brewster Bobbie 34523523543 CrCl mL min 109 Black Bertha 32423452354 CrCL notrecorded Horrible Horace 3242343434 JCrCL mL min 70 Trouble Trevor T324234234 CrCL notrecorded Once you locate the patient record e complete a Follow up Questionnaire section 4 3 AND e add another Follow up questionnaire scheduled for the next review date section 4 3 1 back to Complete a Follow up page back to Detailed Workflow page 2014 New Oral Anticoagulants non VKA Section 417 27 2 3 1 Schedule a Follow up Non VKA Black Bertha 01 04 1974 32423452354 4 The Square Dabigatran Contacts Risk dass Low Pref dinic Default Clinic 5t Elsewhere p Dabigatran therapy is managed using Que
182. e completely any such potential for this type of error Managing Patients Appropriately The DAWN AC maintenance module is designed for stable patients only Patients who are not within this category should be segregated and managed differently ie by using the induction module or dosing manually Some examples of patients who are not within the stable category are as follows for example Patients with high INRs Patients with low INRs e g especially those with mechanical heart valves Patients recently admitted discharged Patients on bridging or preparing for procedures e g cardioversion colonoscopy Patients on induction therapy Patients with miss days dose instructions Patients with boost days dose instructions Patients starting and stopping interacting medications Patients who have had recent or recurring adverse events Checking Clarity of Dose Instruction to Patient Healthcare Professional Itis essential to ensure that any dose instruction messages printed emailed faxed are clear and unambiguous As well as the format of the instruction itself users need to check that the anticoagulant instructions are clear ie that the number of 2014 Safety Section 23 tablets or milligrams is displayed any conditional entries such as any boost or miss days are correct and there is no scope for confusion If your dosing instructions are configured to display decimals rather than fractions the potential of
183. e 80 mg instead which works out as 1 14mg per kg Establish the actual dose per kg represented by your largest likely dose rounding and set the Max dose and Min doses accordingly e g 0 8 and 1 2 mg per kg Leave the Upper and or Lower limits blank to define no upper or lower limit on the dose a user can set If you have defined syringe sizes for the LMWH drug the user can only select from available syringe sizes 7 Enter any notes about this regime and its uses These are only visible in this form or in reports and MessageTemplates Upper and Lower dose limits apply to the dose for each injection not the cumulative dose for 24 hours 25 6 Upgrading from pre 7 7 versions of Dawn AC When you upgrade to DAWN AC version 7 7 or later from a pre 7 7 version there are a number of steps you must perform before you can use your Dosing Regimes This section describes the steps and the errors you are likely to encounter if you miss one Unloading and Reloading DAWN AC Importing Default Tablets and LMWH records Hiding Unused Tablet Strengths Selecting Tablet Strengths and Activating your Regimes Switching off Compatibility Mode Updating your Message Templates Permitting Users to Customise Instructions 25 6 1 Unloading and Reloading Dawn AC During the upgrade DAWN AC creates Style Sheet settings that are used to display dosing instructions correctly These are added to your existing system settings but as your applic
184. e Wed Thu Fri In part instr L Line2default Cd mart instr Line Sdefault Tablets 3mg size a Dav In part instr Line4default 82 Inpart instr O Clone Regime 1 Use the Defaults for New Instructions section to define default values for the instructions you create for the regime If you intend all or the majority of instructions for the regime to be DayPattern instructions see Dosing Instruction Types select the DayPattern check box If the daypattern checkbox is selected any new instructions you create for this regime will be daypatterns instructions by default 2 If you intend the majority of instructions in the regime to be non day pattern plain text instructions or daypattern instructions that can be used in Compatibility mode see Working with Dosing Instructions Day Pattern Instructions Compatibility mode use the Line1 to 4 default fields to define any default text for each of the 4 lines of plain text instruction Creating DayPattern Instructions 1 Instructions belonging to a Regime are listed in the Instruction box on the Regime record Click any instruction to open the Instruction Form 2 If you have created a new regime and have not yet defined any instructions the Instruction box shows a There are no items to display message Click on the There are no items to display message to open the Instruction form Instruction Click here to add are no items to display 3 Choose the orange Ne
185. e checks the messages that are displayed if they fail and tips on troubleshooting and rectifying these errors 2014 312 Dawn Version 7 E Manual If all checks pass a pop up confirmation box appears Are you sure you want to perform the action Activate on record Warfarin Mixed You can give a short explanation in the text field below optional 5 Enter any relevant notes in the explanation field this is optional These notes are stored in the workflow history of the regime so can be viewed in reports showing changes to the regime 6 Press the Cancel button to close the confirmation dialog without activating the regime 7 Press the OK button to activate the Regime The Regime status changes to Active and the workflow buttons change to Maintain and Deactivate 8 Once a Regime is active none of its settings or instructions can be edited To change a Regime or Instruction setting you must put it into the In Maintenance state 25 4 2 7 2 1 Validation Checks When you attempt to activate a Regime DAWN AC performs checks to ensure all instructions in the regime are valid complete and contain no duplicates DAWN AC does not allow you to activate a regime if any of the following discrepancies are found One or more Instructions have the Same Avg or Total Dose The Regime contains Missing Instructions The gap between the Highest and Lowest Day for any one instruction is too big Selected Tablets do not mat
186. e diary TherapyTemplate e Trial Message center DrugTemplate Manage messages and pass messages by phone QuestionnaireType GeneralLookupCategory Reports e Team Custom reports Lookup tables Reports Settings Management if i Mod settings C3Clinic View settings MU MessageManagement T Select a locati v Printing Current location for printing Select a location Reports Category induction Maintenance Parameter Nn nf Active Patients 1 R Patient Report List of Health Authorities P LILE be Iur IL Name Addresst Address Town PostCode Telephone NN Normal Tables ES 4 The Square 2 707 015395 63091 015395 62475 HealthAuthority Organisation Ward HCProfessional Clinic PatientGroup LoginLog Clinic diary Meeting MeetingTemplate Test ReferenceRange TestGroup TherapyTemplate e Trial DrugTemplate QuestionnaireType GeneralLookupCategory e Team 3Lookup tables b Reports 3Management 4 pave vel paris Print 1 1 1 50 Dawn Version 7 E Manual 9 1 2 Adding a New Health Authority LiIcense_MaxActiveratientlount Frontpage Name Normal Tables Address1 HealthAuthority Add 4 Organisation don Ward Town HCProfessional County Clinic PatientGrou
187. e instructions in Coumadin 3mg Tablets which are a different shape Alternatively you may wish to take one of your existing single tablet strength regimes and adapt it to include more than one tablet strength The Clone Regime option allows you to make a complete copy of an existing regime which you can then adapt as necessary To Clone a regime 1 Choose Lookup Tables Anticoagulation Tables Regime from the System menu to display a list of existing dosing regimes 2 Select the Regime you wish to clone and press the orange Edit button The dosing regime form is locked to prevent inadvertent editing so a message box appears informing you that you must unlock the form before you can add a new regime 3 Press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document 2014 Dawn Version 7 E Manual Windows Internet Explorer WOR AIMS You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations docume
188. e letters and messages until the next appointment h has been created Select a Direct Print eu printer Select a custom message to send ib iy jons test 005 1 Dosing Instruc e Dosing Instruction CallAssure 21 3 Pop Up Warning Mesage New Road Kendal 000000 GI m You may be unable to create some siters and messages until the next appointment has been created Select a Direct Print Local printer a custom iios ta send Description e Patient treatment summary 30 03 2011 14 36 ey Dosing Instruction 30 03 2011 14 32 e Patient Details Mr Jonny Fish 30 03 2011 14 32 e jons test 005 30372011 14 31 e Dosing Instruction 30 03 2011 14 31 Instruction 30 03 2011 14 22 ERROR LIMABLE TO PRINT THE SELECTED DOCUMENT This document requires the patient s next appointment to be in place before it can be printed Please ensure the patient s dose has been authorised and oa Y Tu the next appointment has been created before printing this document 4 wk Y ma 9 9 9 gto 9 otal mc ga 815 J E 815 E 2014 2 Dawn Version 7 E Manual 22 Test Date Changes for a Warfarin or other Vitamin K antagonist Patient Da P t Scheduled for Wed 22 07 2009 f Clinic Reschedule manually dose
189. e pattern of higher and lower doses is spread as evenly as possible through the week A typical minimum increments pattern is as follows A zero denotes no increment to the days dose 1 denotes an increment Sun Mon lue Wed Thu Fri Sat 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 1 0 1 0 1 0 1 0 1 0 1 2014 Anticoagulants Dosing Regimes and Instructions warfarin 1 0 1 1 1 OD 1 1 for example the instructions for doses between 4 and 5 for 1mg tablets allowing half tablets would be Sun Mon Wed Thu Fri Sat 4 4 4 4 4 4 4 412 4 4 4 4 4 4 412 4 4 412 4 4 4 4 412 4 412 4 412 4 412 4 41 0 4 412 4 412 412 4 412 412 412 4 412 412 412 412 4 412 412 412 412 412 412 412 412 412 412 5 412 412 412 412 412 412 5 412 412 5 4Vo 4 Vo 4Vo 4 Vo 5 412 5 412 5 4 Vo 5 412 5 4 Vo 5 4 Vo 5 5 412 5 9 5 412 5 5 5 5 412 5 5 5 5 5 5 5 5 5 5 25 4 2 8 2 Validating New Dosing Regimes 1 Check that you have not left a gap between the upper limit of one instruction and the lower limit of the next one up If you have and a patient is given a dose which falls into this gap DAWN AC will display a No dosing instruction found message A quick and easy way to check there are no gaps in regime is to check that the upper limit of one instruction is always exactly equal the the lower limit of the next Instruction up 2 Check you have no instructions which overlap for example where the
190. e the orange Up and Down buttons at the bottom of the form to view additional pages of 2014 Dawn Version 7 E Manual tablets To hide or change a LMWH record 1 Choose Look Up Tables LMWHdrug to display the LMW HDrug list LMWHdrug 53 Search for Name DisplayMame DoseUnits Maxdose _ OrderNr InUse FIG m weho 15 EB psa O Eso feo Ju Ju 0 Eandanarim 1 Imalan 10 2 Deselect the InUse check box for any LMWH you do not use 3 Click the edit form record to the left of the LMWH record to display the full detail LMWHdrug Name DisplayName DoseUnits Dose per Kg O Min dose dose Mg Mg LMWH drug5yringeb5ize LMWHdrugRegime Manual e 1 mg per kg once a day One dose 24 hour 1 per 412111 One dose 12 hours e 1 5 ma per Ka once a day One dose 24 hour 30 mg once a day One dose 24 hour 30 mg qi 2h One dose 12 hours Mr 40 ma once day One dose 24 hour IL rderMr Inlse x 4 Amend the display name to be the LMWH drug name as you wish it to appear on dosing instructions Ensure the list of prefilled syringe sizes is correct and complete If you use 2014 Anticoagulan
191. eck that all non attendees are followed up and every patient has an next test date appropriate to their risk level Appoint a competent healthcare professional to carry out the recommended checks Develop written procedures to use with this system to meet your local needs 2014 22 Dawn Version 7 E Manual These procedures should incorporate not only necessary operational steps but safety steps The computer system along with these written procedures should form part of a quality management system Subject this system to external auditing by a suitable quality standards authority Train your staff in the use of the computer system DAWN Clinical Framework provides a number of checks and warnings to try and prevent errors These include alerts and warnings after each dosage calculation having limits outside which dosing cannot occur list views for identifying non attendees and patients with no next test date What Key Safety Areas Have Been Identified The following key safety areas have been identified Correct Patient Identification It is critical that the users ensure that they have identified the correct patient before taking action such as editing information dosing reports or taking any clinical action Avoiding Transcription or Transposition Errors Careful procedures should be derived and instituted to check that any transcription error or transposition of data cannot occur The aim should be to eliminat
192. ee oe ee ee ee a History Personal Treatmentplans Ad Hoc Questionnaires Test Results Interface Warnings Time Comments Mon 04 02 2008 0 00 ve 1 Mon 2101 2008 25 17 50 w 1 2 wk Man 14 01 2008 ZB 17 50 w 1 2 wk hon 07 01 22008 21 00 vw d Mon 314 242007 1 0 21 00 w di Td 2014 1 Dawn Version 7 E Manual 19 19 1 Stopping Treatment Deactivating or Marking a Patient as Deceased When a patient finishes therapy you must stop their Treatment Plan If they are not about to start a new Treatment Plan for an alternative course of therapy you should Deactivate their patient record to free up a patient license If a patient dies you can mark them as deceased automatically stopping any treatment plan The following sections describe how to perform each of these operations Stopping Treatment Deactivating and Reactivating a patient Marking a patient as deceased Stopping Treatment When patient completes anticoagulation therapy you must Stop their Treatment Plan to remove them from list views and reports that list patients on active therapy and to make it clear to anyone else viewing the patient s record that they are no longer being anticoagulated To Stop Treatment Plan 1 Click the Treatment Plan button on the main Patient screen to open the Treatment Plan screen Risk dass Pref dinic default Hosp Phone 015395 63091 home Age Ebr xri Fibrillation
193. een 2014 376 27 1 3 Dawn Version 7 E Manual For Warfarin the History tab shows details of the INR and dose history _ 24 09 0011 3 31 75w Sun Hon Tue Wed Thu Fri Sat 4 wk 2 2 2 2 PILLS 1 MG SIZE PER DAY sal 03 05 2011 2 21 75 w sun Hon Tue Wed hu Pri PILLS 1 MG SIZE PER cat 200872011 21 1 75 wW Sun Mon Tue Hed Ihu Fri 2 2 19 2 l 2 PILLS MG SIZE PER DAY sal 1 5 1 75 W Sun Mon Tue Had Ihu Fri Sat 2 Lii z 134 2 134 PILLS 1 SIZE S PER DAY Overview page Questionnaires for non VKA therapy management Above range 27 Two structured questionnaires help you record all relevant details at the time Dabigatran is Initiated or on Follow up reviews for your Dabigatran patient Initiation Questionnaire section 5 3 1 Follow up Questionnaire section 5 3 2 The questions cover Indications and Risk Factors for Dabigatran therapy renal function including a calculator for Cockcroft Gault estimate of CrCl records for liver function or other tests Contraindicated or Interacting drugs including other anticoagulants or platelet inhibitors a reminder to ensure INR is not 2 or above if switching from a vitamin antagonist Contraindicated conditions Haemorrhagic Risks records for CHA DS VASc and HASBLE
194. egimes which are expressed in mg instead of tablets 5 You can define non day pattern plain text regimes which express dosing instructions in words rather than individual numeric doses for each day For example 5mg Mon Fri 4mg Sat Sun Creating a Dosing Regime 1 Choose Lookup Tables Anticoagulation Tables Regime from the System menu to display a list of existing dosing regimes 2 Press the orange New button to create a new dosing regime The dosing regime form is locked to prevent inadvertent editing so the new dosing regime form is not displayed straight away Instead a message box appears informing you that you must unlock the form before you can add a new regime 3 Press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document 278 Dawn Version 7 E Manual Windows Internet Explorer D wWARNIMG You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again
195. elated records Orders 0 3 Enter the following details in the following fields Field Name The name to display in the LMWH selection list e g Lovenox DisplayName The name to display on the dosing instruction e g Lovenox DoseUnits e g mg or IU 4 These asterisked fields are required Attempt to save the record or close the form without 2014 330 Dawn Version 7 E Manual specifying a value for each of these fields in turn On each attempt a messagebox is displayed informing you that the field is required When you close the MessageBox you are returned to editing form and the field with missing value is highlighted You can only close the form by filling in all of the asterisked fields and saving the record or by choosing cancel in which case the record is not saved naxaparin Enoxaparin Microsoft Internet Explorer The Field must have a unique value For this table N 5 If the Dose is dependent on the body weight of the patient select the Dose per kg checkbox The labels for Dose Min Dose and Max Dose fields are updated to show these values are per kg rather than absolute 6 If the drug is only ever administered in one set dose enter the dose in the Dose field If the dose is absolute e g 30mg enter this amount e g 30 If the dose is per kg e g 1mg per kg ensure the Dose per kg checkbox is checked an
196. elected for import list 2014 Dawn Version 7 E Manual dmport Uploaded file FAXSLPPORT 1 CF vz1Dasing Regimes U54 DEFAULT DOSING REGIMESIDataExchange Default 77 5 Regimes xml Default import policy created at 09 04 2008 16 10 Import Update existi created Support Dawn Dawn Selected records Required records x pul Automatic records Table to import ACbrand 0 0 0 Selected For import Generic WarFariny Mot selected Far import USA Generic WarFarin PSinthrome Sinthrame z Dindevan Dindevany Pheninidione generic Phenindione Pindione Pindione import policv For table ACbrand Import Update existing Selected records x Required records x Automatic records EA Perform import updates 10 Select LMW HDrug from the Table to Import list and move all the records into the selected for import list Uploaded file F DE Clinical Framework Distribyftp v7 8 Dawn Default LIMWH Tablets Brands DataExchange xml Default import policy Import Update existing created at 01 02 2008 13 55 created by Support 45 Dawn Selected records x Required records x Select another file Automatic records Table to import LMWHdrug Mat selected For import Selected Far import Enoxaparin Dalteparin Tinzeparin Fondaparinux impork policy For table LwHdrug Import Update existing Sele
197. ement License _ MaxActivePatientCount Frontpage Normal Tables Healthauthority Organisation Ward HCProfessional Clinic Patientiaroup LoginLog Clinic diarv Meeting MeetingTemplate Test FeferenceR ange i Testaroup Therapy Template Trial DrugTemplate Questionnaire Type GeneralLookupCategory Team Lookup tables Reports Welcome Fou are curent gged an Support 35 With user Too Grade le AT CLINICAI DAWN 2222 Anticoa Patient view Add edit or dose a patient List view Daily routines Attendance and non attendance Consult the diary Message center Manage messages and pass messages by p Reports Custom reports Settings 2014 Settings for DAWN AC 9 5 1 List of Patient Groups Description Organisation Transport patients 45 Dawn Clinical Software 2 x Eg y Trial group Bia Hospital 2 clic on tr ie Farm lc mm I A ICE Fiere arn 2014 2 Dawn Version 7 E Manual 9 5 2 New Patient Group Form Organisation Bia Hospital Members vau can add related records 9 6 Adding a New User profile Several User Profiles can be configured in DAWN and applied to different Healthcare Professionals Some users require read only access while ot
198. enal impairment other warnings Age reduce dose to 150 mg once daily for age Dabigatran Dose Dabigatran 220 mg once daily On activating a treatment plan for Dabigatran several checks are made in the background 2014 New Oral Anticoagulants non VKA Section aa and an error will highlight any discrepancy For example DAWN will e check that the patient has an appropriate Primary Diagnosis and highlight any not recognised as therapeutic indications for the anticoagulant e check that the user has completed a Dabigatran Initiation Questionnaire listing drugs conditions and test results e check the dose of Dabigatran is advised for the Primary Diagnosis e check that the same dose and diagnosis have been entered for the treatment plan and the Dabigatran Initiation Questionnaire 8 The settings for warnings may be updated as new medical evidence emerges using the Look Up Tables in DAWN AC back to Help page 27 1 4 4 Dosing warnings Dose options are clearly presented on DAWN AC for the patient s indication Therapeutic Indication Total hip replacement surgery Valid dosing regimes for this indication are Dosing regime Advice Dabigatran 220 mg Normal dose once daily Dabigatran 150 mg Patients aged over 75 or with moderate renal impairment or at risk of once daily bleeding Dabigatran 75 mg Patients with moderate renal impairment and concurrent treatment once daily with verapamil or at signifi
199. ency are entered automatically according to these settings By contrast if you select a manual regime you set the dose and frequency options yourself for each patient 5 Select the Weight Based check box to define a Dose and upper or lower limits in units per kg for example 1 mg per kg the units e g mg are defined for the LMWH drug as a whole Deselect the Weight Based check box to define a fixed dose and fixed upper and lower limits for example 30mg Please note the Weight Based regime setting overrides the Dose Per kg setting defined for the LMWH drug as a whole This means you can set up a LMWH drug with a default fixed dose of 30 mg every 24 hours but define a regime which allows you to calculate weight based doses such as 1mg per kg every 12 hours When you select the drug the dose defaults to 30 mg However if you then select the Regime the dose is recalculated as 1mg per kg every 12 hours O Enter an appropriate Upper Limit Lower Limit and Dose for this Regime If you have selected the Weight Based checkbox the doses you specify here are doses per kg When defining these limits allow sufficient headroom for rounding the dose to the nearest pre filled syringe size if appropriate For example if a patient weighs 70 kg and the dose is 1mg per kg the patient s theoretical dose is 70mg However if the nearest pre filled syringe size is 80 mg it is necessary to prescribe 80 mg instead which works out as
200. ent Welcome License MaxActivePatientCount You are currently jogged on Support 45 with user profile Top Grade C Frontpage Patient Click here to go List view into the list DA W N 7 Message Center views e Reports Anticoagulati Normal Tables Lookup tables Reports Patient view Q Management amp Add edit or dose a patient Click here to go into the list 77 List view Daily routines views e Attendance and non attendance to Diar ras y Consult the diary Message center 5 Manage messages and pass messages by phone Reports Custom reports Settings Modify your personal settings Current location For printing Select a location 2014 11 2 List Views 2014 List view List Views What are They All v All patients v All risk classes All diagnoses Any target range v Al J All clinics Any date All CETTE All teams teams J Work List Clinic Lists Non Attendance Procedures Qinic Summary Reminders Treatment Notes Filter With Scheduled Tests records Found TestDate INR Target TIR Drugs 09 00 yetanother test 09 07 2009 0 00 2 50 40 09 00 Pye Delia 25 06 2009 0 00 2 50 100 09 00 Fielding Nina 31 07 2009 0 00 2 506595 High 09 00 Ferguson Stacey 18 11 2009 0 00 2 50 100 Yes High 09 00 induct
201. er of the Anticoagulant drop down list box displayed in the setup screen for related records such as dosing regimes and the order in which the records are displayed in Anticoagulant Look Up Table list used to select and edit anticoagulant records 8 Check the InUse checkbox to include this record in the drop down list of selectable anticoagulants displayed in the Regime set up form Uncheck this box to remove the anticoagulant from the drop down list 2014 Anticoagulants Dosing Regimes and Instructions warfarin 25 4 1 2 AC Brands 2014 1 In some regions such as the USA there are a number of different brands of certain anticoagulants For example Coumadin Jantoven and Barr warfarin are all different makes of warfarin In some cases patients know their anticoagulant by the brand name rather than the generic name for example Coumadin rather than warfarin If a patient changes their insurance they may be obliged to move to a different brand If you set up Coumadin and Jantoven as different anticoagulants you would not be able to move a patient between Coumadin and Jantoven dosing regimes without starting a new treatment plan even though in this case the doses are directly equivalent Instead DAWN AC allows you to set up different brands of an anticoagulant Choose Lookup Tables ACBrand from the System Menu to display the ACBrand lookup table ACbrand 73 Search for Mame CD p X e
202. ersion 7 E Manual in this Daily regime the instructions step up by gt mg per day In other words each instruction tells the patient to take gt mg more each day than the previous instruction In this style of regime the step is easy to see in Daily regime showing the Daily Average Dose but again the same holds true for a Weekly regime where the numeric dose is expressed as the Total Weekly dose The step between the instructions is still mg every day but the difference between the Total Doses is 0 5 mg multiplied by 7 to give the total difference of the week To make things easier DAWN AC defaults the Max Step between instructions setting to the Minimum Tablet Part of the Smallest Tablet Strength you have selected for the regime You must then select whether each instruction increments by this amount over the whole week or by this amount every day Max step between instructions 0 5 mg per Week HaxInstructionDoseIncrement 0 5 As a general rule of thumb set the Max Step settings to the default amount Per Week for Minimal Increments regimes Or Per Day for Same Dose Daily Regimes DAWN then automatically calculates the MaxlnstructionDoselncrement the maximium amount by which the Average Daily or Total Weekly dose for one instruction can differ from its adjacent instructions This figure is used to identify missing dosing instructions When you add a dosing instruction you enter the dose the patient shou
203. es co e SEP Ove ua haces a eee 177 Wizard Screen Entering Treatment Plan errore reri rin une ce run nau y huy a noon ian nu E rac E aaa y Ryan Rau 178 Wizard Screen Next or Kin Details iue cene e uae 178 Wizard Screen Clinical Details ere deese Donee ene ue neue queas 179 Wizard Screen Contact Defalls i iioi e ua 179 New Patient Scree C PP 180 Adano m cie ETE LI cts 180 Stopping Treatment Deactivating or Marking a Patient as Deceased 182 e RR 182 Deactivating and Reactivating a 183 Marking a patient as 1 1 1 1 185 Dosing a Warfarin or other Vitamin K antagonist Patient 188 Entering INR and Test FERE 188 d e 189 Detailed Treatment mee 190 Entering INRs Significantly Different From 5 1 191 Entering INR Date That is Not
204. ested Next 4 12 2007 EE 4 d Graph History Personal Treatment plans Ad Hoc Questionnaires Date INR Dose Time DNA In range Comments Y Fri30 11 2007 10 5 004 4d When you edit a day pattern instruction you need only enter the LMWH details as the rest has been already set automatically Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 0 Low Y Date 30 11 2007 Tate Sat Sun Mon ils 1mg 1 jf L EE 55 Sun Mon E at Sun 1 2 p no previous dose Dose 5 00 d LMWH Enoxaperin 1 ma per Kg T Status Tested Mext na 12 2007 4d 12h single amount W Patient s weight 76 2 kg 168 0 165 Measured 27 11 2007 Graph History Personal Treatment plans Ad Hoc Questionnaires Date INR Dose Time In range Comments Y Fri 30 11 2007 10 5 000 BA 4d Ensure Induction patients appropriate dosing regime dosing regime should e bea Same Dose Daily format see Setting Up Regimes and Instructions Regimes and Instructions Tips on Creating Dosing Instructions for an explanation of Same Dose Daily e use tablet strengths that can achieve any dose specified in the protocol e match the Daily Weekly setting of the Induction Algorithm all Induction Algorithms supplied with DAWN AC and most published protocols
205. estionnaire and these will show contraindications warnings for Dabigatran where renal function is impaired e measured creatinine clearance laboratory estimation e serum creatinine e Cockcroft Gault estimation of creatinine clearance e other measures may be recorded in the notes box Guidelines recommend using an estimate of creatinine clearance rather than an eGFR calculation when dealing with patients on Dabigatran anticoagulation DAWN AC provides a calculator for estimating renal function from serum creatinine and body weight Enter these 2 values and click on the Calculate Cockcroft Gault CrCL Measured Creatinine Clearance mL min Cockcroft Gault estimate of CrCI 1 23 x 140 age years x weight kg x 0 85 if female Cockcroft D Gault MD Nephron serum creatinine pmol L 16 31 41 1976 Serum Creatinine 188 moll High Body Weight 59 kg Gender Female Age at due date 70 2f mL min Contraindicated severe renal impairment Please be aware of the limitations of estimates of renal function in relation ta muscle mass race and diet Note if you have a laboratory estimation which if less than a numeric value like lt 30 please enter the number like 30 in the Measured Creatinine Clearance or Serum Creatinine boxes oimilarly for results which are reported as greater than a value like gt 220 please enter the numeric value like 220 2014 New Oral Anticoagulants non VKA Section 4
206. et size s For vitamin antagonist dosing 1 DAWN AC calculates a suggested dose for a patient based on their current INR result and previous INR and dose history This dose is a numeric value which can be either the average daily dose or the total weekly dose according to your preference However the calculated dose might come out as 4 81 or 31 17 or something equally unachievable with the tablet strengths available Consequently DAWN AC uses tables of Dosing Instructions to look up the nearest achievable dose and present this as an instruction showing the number of tablets of a give strength or the number of mg the patient should take on each day of the week The numeric average daily or total weekly dose is then rounded to the average or total dose represented by the instruction so that it accurately reflects what the patient is actually going to take 2 A Dosing Regime is a set of default dosing instructions covering all doses that might possibly be calculated for a patient At least one dosing regime must be defined for each oral Anticoagulant used e g Warfarin Phenindione in order to create dosing instructions Itis possible to define more than one Regime for a single Anticoagulant to cater for different single or combined tablet strengths or even different patterns of dosing e g half tablets permitted or whole tablets only However once treatment records exist for a patient on a particular Anticoagulant you can only change their
207. ete the answers Mark as complete On marking the answers as complete you are confirming that DAWN AC can store this record display a summary on the questionnaires tab and check details against the treatment plan If you ve added some details in error Cancel your changes using or the rewind button at the top of the screen DAWN If you need to delete a questionnaire completely look for the bin symbol on the questionnaires tab and save before confirming you wish to delete this record JQuestionnaireType Entry date wabigatran Follow Up 02 10 2012 Scheduled eeLabigatran Initiation 07 09 2012 CrCL not recorded Dose 150 mg once daily If you need to add more information or adjust the Initiation Questionnaire which is already completed 1 locate the completed questionnaire on the Questionnaires tab 2 select Unlock to edit Unbeck to edit 3 Save your changes 2014 New Oral Anticoagulants non VKA Section a NB unlocking a previous questionnaire to edit it may cause the details to be updated with subsequent changes to the patient details For example if the patient was previously on an interacting drug which was later removed from your DAWN AC database the drug would still be stored in the old completed questionnaire On unlocking the old questionnaire the record for this drug may no longer be available back to Initiation Questionnaire page 2 2 1 2
208. ets Brands DataExchange xml file from the ftp site to a folder on your PC 3 Open DAWN AC and press F5 to display the system menu 4 Choose Management System DataExchange to display the DataExchange form and select the Import tab Polar DataExchange Please give the File to import Upload E Browse 5 Press the Browse button and select the DAWNAC Default LMWH Tablets Brands DataExchange xml file you have just downloaded then press the Upload button The list of AC Brands is displayed 6 Ensure all the Default Import Policy checkboxes in the top right hand corner are selected 2014 2 Dawn Version 7 E Manual Default irport policy Import Update existing Selected records X x Required records X x Automatic records i 1 7 Press the add all button circled in red below to move all brands into the Select for import list you can hide the ones you do not need later Import Uploaded file F XSUPPORTY CF Y7 Dosing Regimes U54 DEFAULT DOSING REGIMESYIDataExchange Default v _U54_ Regimes xml Default impart palicy created at 09 04 2008 16 10 created by Support Dawn Dawn Selected records Select another file Required records Automatic records Table to import ACbrand Mot selected For import Selected For impart Generic WarfFarin Coumadin LIS tCoumad
209. ettings to the Interacting Drugs table 2014 404 Dawn Version 7 E Manual back to Initiation Questionnaire page back to FAQs page back to Interacting Drugs Settings page 27 2 1 2 6 Interacting drugs some interacting drugs may be known to be increase the haemorrhagic risk if used along with the chosen anticoagulant See relevant published prescribing guidelines Please tick any drugs if your patient is currently prescribed this drug Interacting Drugs AMIODARONE ASPIRIN CLARITHRON CIN CLOPIDOGREL DICLOFENAC IBUPROFEN KETOPROFEN NAPROSYN QUINIDINE VERAPAMIL selecting one or more listed drugs will cause some advice to be displayed on screen like this Interacting Drugs AMIODARONE CLOPIDOGREL ASPIRIN Close clinical su rveilance looking for signs of bleeding or anaemia CLARITHROMYCIN CLOPIDOGREL QUINIDINE For prevention of VTEs after hip or knee DICLOFENAC surgery dosing should be reduced to IBUPROFEN 150mg per day taken once daily as 2 capsules of 75mg dabigatran etexilate KETOPROFEN Close clinical surveillance particularly in NAPROSYN the occurrence of bleeding notably in V QUINIDINE patients having a m VERAPAMIL The list of drugs displayed and the advice displayed on screen are defined in the Look Up Tables on your DAWN AC database Updates to the advice or additional drugs may be added to this list as required Please contact your system administrator t
210. figure DAWN AC to print a dosing instruction automatically when you accept a patient s dose Depending on certain settings and preferences each message can be sent to a printer faxed emailed or forwarded to the Message Center for telephoning To enable automatic and bulk messaging you must to create a Print Station in DAWN AC and associate this Print Station with your organisation and specific locations within your organisation When each user logs in any messages that are triggered in response to things they do doses they accept non attenders they reschedule are handled by their organisation s Print Station These messages are printed faxed or emailed by a separate application called DAW NMailer which connects to a specific Print Station and sends out all the pending messages to the right location Drivers for all printers at each location should be installed on the server Should you have identical printers at different locations the drivers would need renaming to reflect this Steps needed to be set up for Automatic Messaging 1 Setting up a Print Station 2 Setting Up DAW NMailer to process Messages for a Print Station 3 Setting up a new Paper Type 4 Mapping Printers with PrinterPaperT ype 5 Setting Up a New Printing Location 6 Selecting Paper Type in Message Template 2014 Setting up Printing User Guide 161 7 Selecting Paper Type in Message Event 16 1 Setting up a Print Station e Press F5
211. from activating it See the section Activating Deactivating and Maintaining Regimes Activating a Regime Validation Checks Missing Instructions for further details 7 See the section Setting Defaults for New Instructions for advice on filling out the Defaults for New Instructions fields 8 Please Note Miss and Boost Days are expressed in mg if the patient s regime is expressed in mg for example Take 0 00 mg for 2 days Take 7 50 mg for 1 day 25 4 2 1 2 Creating a Regime Expressed in Single Strength Tablets 1 Follow the instructions in the preceding section Creating a Dosing Regime to create a new regime and set the general settings 2 Choose Tablets from the drop down list of DoseUnits options to create a regime expressed in single strength tablets 3 Click the drop down list of tablet strengths to view the options If you have selected brand the list of tablets includes only tablets for this brand If you have not selected a brand tablets marked as In Use for all brands are displayed It is advisable to mark tablets for brands that you do not use as Not In Use so they are not available for selection 4 Choose the tablet strength you wish to use from the drop down list of Tablets The numeric tablet size is automatically updated with the size of the tablet you select Once instructions have been designed for the regime if you change the selected tablet to another tablet of a different strength the upper and lo
212. g D aae rarum etx cera et t Pat eek Pectore es ey 322 Deactivalng a 324 Tips on creatimg dosing Irstt 325 Creating Dosing Ins uC tons DM 326 Validating New 5 0 vies ord nut rennen v rea aep erneuten ve er nenne 327 5 Setting up LMWH and Pentasaccharide 328 hiheEoddieilce 331 PAGING a SY TINGS tumeur cade INN A aS LUC 333 Defining Different Dosing and Administration REGIMES 1 1222 333 Creating an automatic nnne nns 336 Creating a manual LMWH drug e i de rated ea sedute 338 6 Upgrading from 7 7 versions of Dawn 339 Unloading and Reloading _ 2 222 onec e cera cec ene ee eu e rere e scan eos e serra see 339 Importing Default Tablets and LMWH records s essere 340 Hiding Unused Tablet Strengths Lo E ue
213. g Anticoagulant page Bridging VKA Anticoagulation with LMWH For customers who use the DAWN AC Anticoagulation system LMWH heparin doses may be a32 Dawn Version 7 E Manual in DAWN AC within a VKA treatment plan using customised dosing options Sun Mon Tue Wed Thu Fri Please see section on Setting up LMWH and Pentasaccharide Agents back to Changing Anticoagulant page 27 4 Viewing Patient History Your patient may have several consecutive treatment plan records and only one of these may be active for their current anticoagulation Stephenson Hedley 09 06 1938 123 Risk dass Pref dinic None selected Phone home Age 74 Total hip replacement surgery 28 08 20127 Indefinite Dabigatran 220 mg once daily To see previous treatment plans click on the Treatment Plans tab bottom right on your patient screen 2014 New Oral Anticoagulants non VKA Section 4 a Treatment plans gt AC Anticoagulation 29 08 20121 Indefinite Hon VKA Dabigatran 220 mg once daily Start date 16 08 2012 1 Duration Treatment stopped Stopped at 20 08 2012 12 37 Target range 2 5 3 5 3 0 Target Anticoagulant Acenocoumarol Whole Tablets in Mg Daily Ava Referring GP Consultant Notes pa compliance TIR 35 EN If your patient does not have a current active treatment plan record on DAWN the patient may not appear on
214. ganisation ward HCProfessianal Clinic Patientroup LoginLoq Clinic diarv Meeting MeetingTemplate Test ReFerenceRange Testaroup Therapy Template e Trial DrugTemplate Questionnaire Type GeneralLookupCategory Team Lookup tables Reports Settings for DAWN AC Welcome Fou are coment lagged on az Support 45 user profe Too Grade D L CLINICAI Y i FRAMEWORK Antiz Patient view edit dose a patient List view Daily routines Attendance and non attendance CS Consult the diary L1 a Message center Manage messages and pass messages be ia Reports Custom reports Settings Dawn Version 7 E Manual 9 41 List of Wards Ee cs Hospital obari 2014 Settings for DAWN AC 8 9 4 2 New Ward Form Organisation Description Kis hil need bo save this new record before b Treatment plans InUse ec EI e 9 5 Adding a New Patient Group Optional Patient groups are used to group together a subset of patients for use in reporting list views research purposes etc Patient groups are not a mandatory section to be filled in within DAWN 2014 Dawn Version 7 E Manual LicenseA amp gre
215. gin to DAWN AC in the normal way the very first time you open each form the application may be slower than normal 25 6 2 Importing Default Tablets and LMWH records If you have upgraded to DAWN AC 7 7 from an earlier version of DAWN AC you can import the default set of warfarin tablets brands and LMWH records you need to get started with DAWN AC 7 7 You may have downloaded and imported these records as part of the upgrade process itself To check whether you have already imported the default warfarin Tablet and LMWH records 2014 Anticoagulants Dosing Regimes and Instructions warfarin 341 Press F5 to display the system menu 2 Choose Look Up Tables LMW Hdrug to display the LMW HDrug list If the list is empty you have not imported the LMWH drug records 3 Choose Look Up Tables ACBrand to display the ACBrand list If the list is empty you have not imported the ACBrand records 4 Choose Look Up Tables Anticoagulation Tables Anticoagulant to display the Anticoagulant list 5 Choose warfarin from the list of Anticoagulants and check the child list of Tablets If the list is empty you have not imported the warfarin Tablet records If you have not imported any of these items you can import them all in one go by performing the following steps please note you must have internet access 1 Call the 45 team on 0 15395 63091 to obtain ftp site details 2 Copy and Paste the DAWNAC Default LMWH Tabl
216. gnosis Click on the filters on the left of the list view screen to tailor the list you wish to view 2014 New Oral Anticoagulants non VKA Section 375 The Patient Search and Reports screens also provide searches on your DAWN AC database for patients on different anticoagulants Overview page Detailed Workflow page 27 1 2 Integrated non VKA patient record The DAWN AC patient record accommodates treatments with warfarin and non VKAs like Dabigatran etexilate Each patient has a treatment plan when they start a particular anticoagulant treatment The treatment plan defines the key elements of the treatment such as dose duration etc AC Anticoagulation 01 08 20127 Indefinite non VKA Anticoagulant Dabigatran 75 mg once daily WESTWAY MEDICAL H CENTRE EVAMS V W The Big Hospital BRIDLE 5 J 25 02 2008 Treatment stopped Stopped at 01 08 2012 04 24 PM 2 0 3 0 2 5 Target Warfarin 24mg Strength in Mg Daily Avg WESTWAY MEDICAL H CEMTRE CROFT K G Prince Regent Infirmary Cleverson Caral 1475 Poor compliance For Dabigatran the anticoagulation history is accessed from the Questionnaire tab QuestionnaireType Entry date Summary E Dabigatran Follow Up 02 07 2012 Overdue e Dabigatran Initiation 15 06 2012 CrCL mL min 91 Dose 110 mg twice daily See below for full questionnaire scr
217. has actually been taking When you enter the next INR the new dose calculation uses this adjusted actual dose as the basis for the next dose To adjust the last dosing instruction dose 1 Click the date of the last dose in the dosing history to display the record 2 Double click the dosing instruction If the next dose has not already been calculated the Edit View actual dose the patient took screen is displayed A Message box is also displayed informing you that amending this dose retrospectively will not create a new prescription for the patient but may influence the next dose calculation 2014 254 Dawn Version 7 E Manual Treatments for yetanother test 01 01 1966 Anticoagulation 14 05 2009 Warn IHRDate IHR Dose M dose days Dosing instruction partial O 2009 w O nsnz200928 400 MON FRI 3mq SATUN O 67 2406 200917 16 00 MON FRI 3mg SATUN O 1705200834 14 00 2 mg DAILY O B nsmsm00927 16 00 MON FRI 3mq SAT SLM r1 Iz ST Mrd d gua 4 ee 1 067 T AE dB INR 2 8 InRange T Date 09 07 2009 Y w Sun Mon Tuel Wed Thu Fri M Microsoft Internet Explorer Warning You are going to edit the Actual dose the patient took the last period This is not a prescription For Ehe comming period but may influence the dose that will be calcula
218. have been set up and checked for correctness For each target range Ensure the result status records e g low in range high have been defined with the correct lower and upper limit values Ensure all the INR triggers have been correctly defined Particular attention should be paid to ensure the lower and upper limit values have been correctly entered together with the appropriate action e g warning calc prevention Ensure all the interval rules have been correctly defined with the correct lower and upper limit values Ensure all the miss or boost rules have been correctly defined with the correct lower and upper limit values Safety Check List for Clinic Diary Settings Ensure there are adequate time slots for a typical day s patients list Check that any adjustment you have made to the diary for a clinic has been properly made in the diary Ensure your days are adjusted or excluded for known staff absences etc Ensure that the system settings are set to maintain a diary for the appropriate weeks ahead for your centre Ensure that the system settings are set to retain the diary for the appropriate weeks in the past for your centre Any deletion of diary slots should be undertaken under strictly controlled conditions and after a backup has been taken Safety Check List for Defining Procedures Letters and Events Ensure all procedures have been defined correctly in the Procedure look up table and have been made availab
219. he ranges of VGR and values and the descriptions and colours associated with each range Between 2 and 5 ranges can be defined for each indicator It is also used to define the minimum number of INRs which need to be recorded for a patient in the relevant period before the and the can be calculated The default VGR settings included with the installation are shown in the screen shot below VGR Setup Screen Password E 1 s m 7 Hin Value Caption Colour Min Value bore Ave Seow Averoe NOS bem 708 fem s Below Average Above Average s568055 95 _ _ _ Minimum Number of INRs in 3 Month Period to Calculate VGR min 2 Minimum Number of INRs 6 Month Period to Calculate 6 Month 9 amp TIR 2014 464 Dawn Version 7 E Manual Index 7 7 Dosing 226 AC Brands 271 Accept Instruction 192 Accessing List Views 142 Accessing the Clinic Diary Clinic Diary screen 139 Adding a Blood Group 101 Adding a New Patient 175 Adding Clinic Details 84 Adding history Historical INRs 180 Treatment History 180 Adding Slot Templates 85 Adding Teams 75 Adding Editing a Message Event 128 Adding Editing a Message Template 125 Adding Editing
220. her Vitamin K antagonist Patient 20 6 Amending the Dosing Instruction 1801 Rd INR 3 7 High Y Date an Sun Mon Tue wed Thu Fri S MEM NUR NT NC Change 3 is 45 00 Next inen F009 decreased by 10 La atus Tested Accept dose History i SBE 100 he lov Fri Tue 14 04 21 Or Click an Calendar and choose Wed D8 D4 2008 2 1 21 00 w 1 Tue OF 04 2009 ae 2100 20 6 1 Dose Decrease Sat eS Dose decreased by 30 Dose 85 00 Status Tested Next losforizooa E53 7 d Accept dose E 4 1 2014 194 Dawn Version 7 E Manual 20 6 2 Dose Increase 1801 Paremill Rd Warfarin Sun Mon Tuel wedl EN Fri Sat ills 10 mg 10 Total m Bu zl 10 5 10 5 H Ho change Status Tested Next lpsjmzrenne ES 7 d Accept dose 20 6 3 Undo Dose at scheduled Schedule manually No warnings Treatment note 4 dose zero Dose 0 00 w Status Scheduled Accept INR Un schedule i L 2 ory 2014 Dosing a Warfarin or other Vitamin K antagonist Patient 20
221. hers will need to edit certain values in DAWN See also the Personal Settings on the Front screen of DAWN each user can further modify their own access to parts of the DAWN system 2014 Settings for DAWN AC LicenseAgreement Welcome License_MaxActivePatient aunt Fou currently ogged an Support 45 with uraer orate Tao Grace Frontpage i Normal Tables me 7 Tere ss Lookup tables c D J c LIN 1 L 7 Reports eFikeyonyour FRAMEWORK f Management Clinic View settings MessageManagement Printing Anticoaguilat Reports Patient view Cal ED ddd edit ar dose a patient Parameter Report List view Daily routines Attendance and non attendance Polar Reporting UserProfile Workflow log n M changes DatabaseConversianLog X 5 nage Messages ar mezzagez one Update database 5 3 F ges by p DawniInterface System CodedComment lt Custom reports Settings modify your personal settings 2014 64 Dawn Version 7 E Manual 9 6 1 Viewing and Editing Existing User Profiles Description gt Top Grade Middle Grade Lower Grade Patients Interface Description AllowtreatePatient AllowEditPatientData AllowthangeRisktlass AllowEditPatientOrganisations AllowDeactiyatePatient
222. icoagulants Dosing Regimes and Instructions warfarin 325 MEA Wartarin 1 amp Sma with Halves Weekly In Maintenance Undefined weekly E WARFARIN 1 WEEKLY DOSE Weekly Active WARFARIN 1 Mi WEEKLY DOSE Clone Weekly In Maintenance 3 E WARFARIN 10 MG WEEKLY DOSE Weekly Active Warfarin Img Strength rin Ma Daily Sa Daily Warfarin Img Whole Tablets in Ma Daily Avg Daily OO WARFARIN T S Week Ty Active pal ahame WARIDW Inlse X Description E Status EIDEM Anticoagulant Brand Generic Daily Weekly Weekly DoseUnits Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine Tablet 1 Tog Pills 10 ma white USA Generic 10 Instruction record 1 50 f 70 a 7 5 5 00 12 5 10 00 17 5 15 00 22 5 20 00 27 5 25 10 32 5 30 00 37 5 35 00 42 5 40 00 42 5 47 5 45 00 step between instructions 5 mg per Week MaxInstructionDoseIncrement 5 DayPattern Line 1 default In part instr LineZdefault In part instr Line 3default In part instr Line 4defaulk In part instr m 4 Press the Deactivate button The Regime status changes to Deactivated and the workflow buttons change to Activate and Maintain 5 Once a Regime is Deactivated none of its instructions can be used to dose a patient 25 4 2 8 Tips on creating dosing instructions The fol
223. idating New Dosing Regimes to check your instructions are complete 7 Follow the instructions in the section Activating Deactivating and Maintaining regimes to activate your regime The procedure for changing the tablet strength of a single strength regime is exactly the same except you do not change the Dose Units You simply change the existing tablet strength The instructions are recalculated in the new tablet strength Do NOT activate a regime containing instructions that have been calculated automatically without validating them thoroughly first You are NOT permitted to make any of the following changes to regimes that already have instructions as they would invalidate some or all of the existing instructions e Switch a regime from mg to Tablets and vice versa e Change the smallest tablet strength for a regime in mg e Remove or change existing tablet strengths for Mixed tablet regimes that have more than one tablet strength selected e Switch from mixed tablets to single strength tablets e Change the Anticoagulant You are permitted to make the following changes 2014 Anticoagulants Dosing Regimes and Instructions warfarin e Change tablet strengths for regimes in single strength tablets or in Mixed tablets with only one tablet strength selected e Change from tablets to mixed tablets e Add additional stronger tablet strengths to Mixed Tablet regimes e Changing from Daily to Weekly and vice versa 25 4 2
224. igatran therapy e Regime and Non VKA section 15 5 set a completely new dosage and dose settings 2014 27 7 1 27 1 2 2014 New Oral Anticoagulants non VKA Section 437 Dose e General Lookup section 15 6 adjust the dropdown menus for CHADS or Category Settings HASBLED scores For help and advice on editing any settings in your DAWN AC system please contact support 4s DAWN com Therapeutic indications Please Note The appropriate anticoagulant diagnosis and regime need to be added to the DAWN system if they are not already there before proceeding to the step below The primary diagnosis for your patient has to be set as a valid qualifying diagnosis or therapeutic indication for the particular anticoagulant For example the settings for Dabigatran may be as shown Therapeutic Indications Ej Dabigatran 22 Atrial fibrillation nonvalvular 2 Dabigatran 150 mg twice daily Dabigatran rD ORTHO HIP Total hip replacement surgery T9 Dabigatran 220mg once daily IS Dabigatran 2 ORTHO KMEE Total knee replacement surgery 2 Dabigatran 220mg once daily Add to these settings as required as new medical evidence emerges so that an anticoagulant is known to be approved for use with a particular primary diagnosis NB deleting entries on this table may result in multiple patients not getting a dose or next appointment back to Settings for New Oral Anticoagulants page Qua
225. igure the system to show the tablets in fractions but the Total Mg line in decimals by switching the DisplayDosinglInstructionsInDecimals to 0 off and switching the AC DisplayDosinglnstructions ShowTotalMglnDecimals to 1 on Customizations ame CONUM Description AC_DisplayDosingInstructions_ShowTotalMgInDecimals Should the Total Mg line of a dosing instruction always be displayed in decimals regardless of whether the tablet lines are shown in fractions O No 1 Yes AC DisplayDosingInstructionsInDecimals b Must the AC dosing instructions be displayed using fractions 0 or decimals 1 The instruction now shows the doses expressed in tablets in fractions while showing the Total Mg line in decimals Mon Tue P E Fri 2014 Anticoagulants Dosing Regimes and Instructions warfarin lt The DisplayDosinglnstructions ShowTotalMgInDecimals only affects the calculated Total mg line that can be displayed for instructions expressed in tablets This setting is ignored for other types of instruction that do not include a calculated Total mg line or where the AC Display TextStyleDosingInstructions system setting is set to 1 on HINT oee the section Editing System Settings for instructions on how to change system settings If your dosing instructions are configured to display decimals rather than fractions the potential of misreading a decimal in the dosing instructions should be
226. in Janteven LUISA Jankaven Barr LI5A Warfarin z k ndevan Dindevan eninidione generic Phenindione Pindione tPindiane import policy For table Acbrand Import Update existing Selected records x g Required records X 2 Automatic records m Perform import updates 8 Select Anticoagulant from the drop down list of Tablets to import and press the add all button to move all the Anticoagulant records into the Selected for import list 2014 Anticoagulants Dosing Regimes and Instructions warfarin ws Uploaded file F ASUPPORTI CF vzYDosing Regimes U54 DEFAULT DOSING REGIMES DataExchange Defaulk vr LI5A created at 09 04 2009 16 10 created by Support Dawn Dawn Select another Table to import ACbrand Mot selecked Far import Selected Far import UK Generic WarFarin Coumadin USA Caumadin Jantoven U54 JanEeven Barr 5 11 Taro LISA Warfarin U54 Generic WarFarin tSsinkhrame Sinkhrame Dindevan Dindevan g Pheninidiane generic tPhenindioi Pindiane import policy For table Acbrand Import Update existing Selected records X E 1 Required records Hd Automatic records p Perform impart updates 9 Select AnticoagulantTablet from drop down list of Tables to import and press the add all button to move all the AnticoagulantTablet records into the S
227. in DAWN AC 2 Update each user s Healthcare Professional Account record with their Network ID 3 Disable anonymous access to the DAWN AC web site in Internet Information Services to ensure that users connect to the web server with their network ID and not with the default Internet Guest Account Enabling Active Directory Support in DAWN AC 1 Press F5 to display the System Menu then choose Management System to display the system options 2 Click on SystemSetting type Domain into the Search for Name field and click the search button TheDefaultNetworkDomain system setting is displayed 3 Enter the name of your active directory domain in the Value field eystemSetting Sorting Tvpe Mame Last changed Search for Mame deFaultmetwarkdamain value Customizations ae O Description Def aultNetworkbomain The default domain Far the netvword used For the automa 172 Dawn Version 7 E Manual 4 Enter ActiveDirectory in the Search for Name field and press the Search Button The SupportActiveDirectory system setting is displayed SupportactiveDirectory 5 Change the Value to 1 to disable Active Directory support change the Value to 0 Updating the Healthcare Professionals Account Records 1 Choose Normal Tables HCProfessional from the System Menu to display the list of Healthcare Professionals Choose the Edit form icon to the left of the appropriate Healthcare Professional t
228. in Text Non Day Pattern Instructions INF 2 9 InRange Date 29 07 2009 ee Smg MON FRI mg SAT SUN Loo fund MU Ao LMWH drug Dose increased by 6 Dose 37 00 w Status Tested La nareona EHE 3 wk Accept dose 1 it is possible to customise a day pattern instruction However the customised instruction is always expressed in mg and each day s dose must be entered manually as there is no day pattern default 2 See the section Customising Dosing Instructions for full details on customising dosing instructions 25 3 16 Day Pattern Instructions compatibility mode 1 If older style DayPattern Instructions have been upgraded from a previous version of DAWN AC they are converted to the new formatted style However the original format is retained AC DisplayTextStyleDosinglnstructions system setting determines whether the new formatted or backwards compatible plain text instructions are displayed INR 2 6 InRange Date 28 07 2008 Warfarin Sun Mon Tue Wed Thu Fri Sat Fills 10 mg 10 Total m 5 5 5 5 5 E 5 2014 266 Dawn Version 7 E Manual Instruction displayed in the formatted style INR 2 6 InRange Date 28 07 2008 Y i Sum Mon Tue Wed Thu Fri Sat 15 15 15 White tablet is 10 strength The same instruction displayed in compatibility mode 2 You cannot customise dosing instruction
229. ing 56 other anticoagulants 424 other non VKA agents 395 Patient Group Adding 59 Editing 59 Patient Group Form 62 Patient History Viewing 432 patient questions 420 Personal Settings Personal Settings Form 80 Personal Settings Form 81 Plain Text Instructions 264 Pradaxa 373 pradaxa 412 Printing User Guide 160 2014 Q Questionnaires 376 R Regime in milligrams 280 Regimes and Instructions Setting Up 267 renal function 390 421 reporting 393 Reschedule Change next appointment 366 Change next test date 366 rewind 400 418 Risk 93 Risk Class 94 Risk Settings Risk Class 91 Severity of Risk 91 Rivaroxaban 375 Rivaroxadan 373 Scenarios 354 schedule 399 417 408 427 selecting a Paper 167 Selecting Paper Type in Message Event 168 Setting up a New Paper 163 Setting up Dawn mailer Processing Messages 162 Setting up New Print Location 164 Setting up Print Station 161 Severity of Risk Setting 92 Single Strength Regime 283 Skip 197 Slot Template Form 86 Standard Induction Algorithms Induction Algorithms 216 starting 409 stopping 414 Switching Off Compatibility Mode 351 oyringe Sizes Adding 333 2014 Index Defining 331 oystem Workflow 18 Tablet 196 Tablet Strength 273 Tablet Strengths Changing or inserting into a regime 301 Test Date 188 Test Date Change 206 Therapy Bridging 214 Induction 214 Maintenance 214 Time 207 Treatment
230. ing to Bleeding D Antiplatelet agent NSAIDs Alcohol Usage History None selected Dabigatran 110 mg twice daily Valid dosing regimes for this indication are Dosing regime Advice Dabigatran 150 mg twice daily Normal dose Dabigatran 110 mg twice daily Patients aged 80 or over or at risk of bleeding Information in this questionnaire is used to influence dosing and therapy decisions Please ensure all answers are accurate and complete 2014 New Oral Anticoagulants non VKA Section back to the Questionnaires 27 1 3 2 Dabigatran Follow up Questionnaire Dabigatran Follow Up Patient Hame Carmella Black Due Date 19 09 2012 Unit No 99999999 Status Scheduled Questions Therapeutic Indication Tatal knee replacement surgery Duration of use 12 weeks Age at due date TU Dabigatran Dose Dabigatran 220mg once daily Over the past two weeks 2014 a84 Dawn Version 7 E Manual have taken the correct dose every day No might have taken too many capsules tablets No might have missed one more doses No take more than 3 other medications regularly No Stomach upset burning pain 0 9 Reasons for compliance problems Has the patient reported any adverse event potentially due to current anticaaqulant Yes Yes Make a choice cost Dementia Fear of side effects Gastroes
231. ion test 15 07 2009 0 00 2 50 High 09 00 Stellar Steven 23 09 2009 0 00 2 50 94 High Lookup Tables What are They 145 12 Lookup Tables What are They From the F5 menu within the system you can access the Lookup Tables These tables can be used to add edit items like risks diagnoses etc License_MaxActivePatient Count fou are currently fogged an ar Support 45 wth user profile Tan Grade _ E DAWN T 5 Normal Tables Anticoagulat Healthauthority Organisation e ward HCProfessional Clinic Patienbiroup LoginLog Clinic diarv Meeting Patient view Ca Add edit ar dose a patient List view Daily routines MeetingTemplate Test ReferenceR ange Testaroup Therapy Template e Trial DrugTemplate Attendance and nan attendance Diary Consult the diary Message center Manage messages and pass messages by phone Questionnaire Type GeneralLookupCategary Reports Team Custom reports Lookup tables Reports Settings 2014 we Dawn Version 7 E Manual 12 1 List of Lookup Tables License MaxActivePatientiaur ae Gummer wu emus 5 Frontpage d 5 Normal Tables Healthauthority organisation Ward Anticoaqulati HCPrafessianal Clinic PatientGroup Patient view G a LoginlLog add edit ar dose a patient Clinic diarv PER Li
232. ires Date INR Dose Time DNA In range Comments Y Fri 30 11 2007 1 0 5 00 dil 4d ouch instructions make sense whether the dose is for one day or seven days but are perhaps not as clear to the patient as formatted day pattern instructions Furthermore if you wish to customise the instruction to include a Low Molecular Weight Heparin dose the format changes to a Daypattern layout INR 1 0 Low Y Date 30 11 2007 2 LMWH None selected w previous dose Dose 5 00 d Status Tested 4 12 2007 4 d Graph History Personal Treatment plans Ad Hoc Questionnaires Date INR Dose Time DNA In range Comments H Fri 30 11 2007 1 5 00 d ifii 4d You must then re enter the oral anticoagulant dose and where necessary change the first day of the week and remove days from the instruction to make it meaningful before you can select the LMWH In version 7 7 onwards you can use formatted day pattern regimes with Induction 1 DAWN AC will automatically adjust the first day of the week and remove unwanted days from the instruction 2014 Anticoagulants Dosing Regimes and Instructions warfarin Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 0 Low Y Date 30 11 2007 gt Mot scheduled Sat Mon 5 5 previous dose Dose 5 00 d Status T
233. is copy of to process messages For this Print Station IF you share Dawn AC with other organisations each organisation can have its own print station and DawnMailer Server address LDOS YS SMTP server Default printer Interval sec Interface key messages sent Total Time of last message Use CDOSYS recommended iv Error 21 46697210 The system cannot locate the object specified Select the printer vou want to use by default You can corfigure Dawn AC to print use diFFerenk printers For different messages and diferent locations This is convered in a separate factsheet hp LaserJet 1320 PCL Submit 5 Test Test Email Test Fas QO Printed Email Fax Press the Test Mail Test Email and Test Fax buttons to print email and fax a test message to ensure DAWNMailer can print email and fax successfully Press the Start button to start DAWNMailer DAW NMailer starts processing any messages for its corresponding Print Station Setting up a new Paper Type Mapping Printers with PrinterPaperT ype e Press F5 to display the system menu and choose Management Printing PrintStation ce E Remote Locked TEMERE BLOO443FD7E47598 mkey l amp 41D amp 6FB8273C9D8 e Edit the PrintStation you want to map printers to
234. isease area PrimaryDiagnosis Start date Duration type Duration Preferred clinic Preferred time Status Za Date of referral Referring GP Consultant Anticoagulation 0000 ATRIAL FIBRILLATION 02 11 First seen date Weeks Days 500 wks Due to stop 25 09 2014 Clinic 45 Dawn Clinical Soft From __ until __ active HE EE admit ee 45 Dawn Clinical Software Supr woodside surgery Stanley lucy start date Duration in weeks Status active 4CTherapy Target range Regime Induction algorithm Sample instruction MaxPercentDoseChange MaxInterval ProblemPatientFlag RA Laboratory None selected Maintenance fea Maintenance Bridaina Sun Mon Tue wed Thu Fri Sat uoo qe 3g 3 31 9 PILLS 1 MG SIZE PER Recalc time in range If the patient is on induction therapy and following an induction protocol then the DAWN system will prompt the user when the patient can be switched over to maintenance therapy If the patient is on bridging therapy then DAWN will force the user to dose manually until the healthcare professional decides to manually move the patient back to maintenance 2014 Frequently Asked Anticoagulation Questions 371 therapy 2014 New Oral Anticoagulants non VKA Section 373 27 New Oral Anticoagulants non VKA Section 27 1 Overview of New Oral Anticoagulants non VKA Features of softwa
235. isks and Specific Risks NB any risks identified on the Follow up Questionnaire will NOT automatically display at the top left of your patient screen see adding Risks for a new patient or click on Risks button to add risks on the patient screen 2014 New Oral Anticoagulants non VKA Section 427 Risk dass High Pref dinic None selected Phone home Atrial fibrillation nonvalvular Hon VKA 05 09 2012 Dabigatran 150 mg twice daily back to Complete a Follow up page 27 2 3 2 11 CHADS and HASBLED scores CHA DS VASc and HASBLED scores may be optionally recorded form the dropdown menus on your questionnaire 8 score None selected 0 2 3 4 5 7 8 9 HASBLED score None selected 0 Risk was 0 9 in study 1 Risk was 3 4 in one study 2 Risk was 4 1 in one study 3 Risk was 5 8 in one study 4 Risk was 8 9 in one study 5 Risk was 9 1 in one study 6 Risk net known too litte data 7 Risk not known too litte data 8 Risk not known too litte data 9 Risk not known too little data The dropdown options are provided from the settings in your DAWN AC Normal Tables General Lookup Category CHA2DS2 VASc Score and HASBLED You may wish to request that your system manager updates the options available back to Complete a Follow up page 2014 am Dawn Version 7 E Manual back to Settings for General Lookup Category page 27 2
236. ist view Daily routines Attendance amd non attendance Diary Consult the diary Message center Reports Custom reports Modify your personal settings Current location for printing No locations available Dav Authorised Doses Chan Dose Changes With Not In Range With Interval Increased By je Date More The 094 An Interval Increase Interval Increase Days More Glick for details Thu 04 04 2013 0 0 0 1 cick here for details Thu 28 03 2013 1 0 0 Mo Action Required Wed 27 03 2013 0 0 0 Click here for details Mon 25 03 2013 1 Q ho Action Required Thu 07 03 2013 MO oc Database name Database size Last Database backup DawnAC 164 4 2013 Actree Patients Unused Licenses Patient Licenses 10000 417 2014 4 Dawn Version 7 E Manual 8 How To Navigate Around DAWN HOW TO NAVIGATE AROUND THE DAWN SYSTEM There are several ways of moving through the different screens within DAWN To log out of the system you can use the Flag icon t Internet Explorer 15 with user profile Too Grade 5 Thu 18 06 2009 D ya Version 7 9 1245 __ Patient view C an Add edit or dose a patient List view Daily routines Attendance and non attendance Internet Explorer as DAWN 2 7 9 Report Time in Range Between Dates he Show repart Download as XML Download as Text ind
237. it or dose a patient List view Daily routines Attendance and mon attemdance B Di ary q Consult the diary Mxdify your personal settings 2014 New Oral Anticoagulants non VKA Section 45 Choose the report from the dropdown menu and select any parameters as required before choosing Show report Patients by Current Drug Count Drug name a EOX Y CYCLINE ACETAZOLANIDE ACT OFAN ACTRON EFF TABLETS ADALAT ADIF AX ALKA SELTZER ALLOPURINOL Department Rheumatology Show repart Download az XML Cownload az Text k penc Rheumatology DMARE Maerharrexate Hydrexychlorequine Z weakly monitoring Hydraxychloroq Sad FEES Bd ad lal V2 8 Se alam III Data may be extracted from DAWN by saving as a text file or e mailing to yourself or a colleague Further data analysis may then be possible using Microsoft Excel or another programme 27 Settings for New Oral Anticoagulants Your System Manager can access settings for Dabigatran and other anticoagulants in the System menu gt Lookup tables 2014 4 Dawn Version 7 E Manual AS DAWN Clinica Internet Applice icenseAgreement Welcome License MaxActivePatientCaul You are currently bx Frontpage Normal Tables Lookup tables Anticoagulation Tables TargetRange INR Anticoagulant Regime Induction Algorithm Resulthange INR ACTe
238. its CrugDurationUnits DrugMedium DrugvalumeLlniEs Frequency e warnLevel e VistTv pe Anticaaqulat Patient view C Add edit or dose a patient List view Daily routines Attendance and non attendance Diary 3 Consult the diary Message center Manage Messages and pass messages by phone Reports Custom reports Settings Modify your personal settings Current location For printing Select a location Category induction Maintenance Expl No of Active Patients 1 Patien Missed Test 0 1 Needs Ma next test date 2 Meed Ma INF today 0 2014 Settings for DAWN 121 9 21 1 List of WarnLevels evel Drugs LE ql 71 7 Always Wer nr 5 a Events e rure e Turmae Ine Werne Qpwaswm B o BE Pracedures Es rere WEITE E Oa Qwaswan Risks m m n x 2014 122 Dawn Version 7 E Manual 9 21 2 Adding a New WarnLevel evel New record pues WarnGroup the Warn Level Name WarnLevel WarningImage AlwaysWarn TestChar alueOption 9 22 Adding Editing Languages If you need to add a language that does not exist in the standard list new languages can be added here 2014 Settings for DAWN 123 C Frontpage Fou are curent logged
239. l Dose Upper Limit Lower Limit Line1 and Line2 fields are all filled in automatically as described in the preceding section Creating DayPattern Instructions Instruction Aartrin new regime LowerLimit UpperLinit Avg dose 1 36 2 04 2 00 LowerLimit UpperLimit avg dose Line1 Sun Hon Tue Wed Thu Fri Sat In part instr Line2 2 2 2 2 2 2 2 In part instr M Pd part instr Pd iv part instr DayPattern x Sun Mon Tue Wed Thu 2014 Anticoagulants Dosing Regimes and Instructions warfarin 25 4 2 2 2 Creating a Day Pattern Instruction in Single Strength Tablets Creating DayPattern instructions expressed in Single strength Tablets is the same as creating DayPattern instructons in mg except 1 The tablet image and caption are displayed as a row header Instruction Warftrin new regime B 1 36 2 04 2 00 LowerLimit Uppertimit avg dose Line1 Sun Hon Tue Wed Thu Fri Sat In part instr ES Line JE ONE an WE In part instr Line3 Pills img size per Day In part instr Line4 U jInpatt instr O DayPattern x Sun Mon Tue wed Thu Fri 2 You enter the dose for each day as the number of tablets rather than the number of mg The Total mg for each day is calculated from the number of tablets and the tablet strength and displayed as a read only check below the number of tablets The Total mg line is always displayed when adding or editi
240. land 4 1 gt of 1 active Risks gt Ferguson Stacey 05 06 1993 2345345345 12 Earls Court breansty Reading f Y Y Date 4 18 1 2009 lt gt Scheduled for wed 18 11 2009 09 00 17 00 in clinic Anticoagulation Clinic Reschedule manually 4 Control Panel No warnings Click Here e Treatment notes dose zero Dose 0 00 w Status Scheduled Accept INR DNA Un schedule History EY Personal Treatmentplans Time DHA T CA Wed 18 11 2009 0 00 vif Y Wed 2810 2009 23 140w 3wk Y Wed 07 10 2009 21 1400 on Wed 1609 2009 21 14009 3wk Big Hospital Support 45 Y Fri 2808 2009 21 14009 3d 1 CRITICAL CASE LEFT MESSAGE 52 2 Y 24 08 2009 21 140096 4d Y Fri21 08 2008 24 14 00 w B wk LE Y Fri10 07 2008 2 1 2004 oo Fri 29 05 2009 21 14009 6 wk Tue 14 04 2009 22 1400 wd Tue 07 04 2009 21 14009 Add history data 20 1 Entering INR and Test Date rs Reading i Risk class Pref clinic Phone Age 16 ATRIAL FIBRILLATION 2 0 3 0 2 5 Target VARI To m 1 History f Wed 18 11 Wed 28 0 H Wed 0710 2009 21 14 00 w Wed 1092009 21 1400 wii n Y 28 08 2009 24 1400 3d 1 CRITICA Hospital Support 45 2014 Dosing a Warfarin or other
241. latest target range recorded for the patient if they have more than one target range recorded for the three month HINT Period The value is calculated to 2 decimal places The VGR calculation is only carried out where the patient has at least the number of non zero INRs recorded in the 3 month period specified on the VGR setup screen This number defaults to 2 and must be at least 2 Maximum Difference The Max Diff field shows the difference between the maximum and minimum INRs recorded for the patient in the same three month period as used to calculate the VGR VGR Fields on the Patient Details Screen When the VGR functionality has been enabled and where the patient has an active Vitamin K anticoagulant regime the VGR traffic light indicators and Max Diff field are displayed at the top left of the Patient Details screen as shown below 2014 Variance Growth Rate VGR 461 BANKS M rk 5 Saree rd LE LEA Tau M 7009 TE PEL Lancet mpra ur Pond ap ri Eur change ia Hi key i Pase ums die Chr Copa m Enlarged Hovering over each of the coloured indicator boxes and the Max Difference value displays a hover box which includes additional information about the selected indicator as shown below The va
242. ld take on each day and DAWN AC 2014 Anticoagulants Dosing Regimes and Instructions warfarin 291 automatically calculates the average daily or total weekly dose and the upper and lower limits for the instruction see section Creating DayPattern Instructions It also updates the upper and lower limits of any surrounding instructions to accommodate the new instruction DAWN AC sets the lower limit of each new instruction to the same value as the upper limit of its preceding instruction and ensures this value is the half way point between the average or total dose of the two instructions For example However DAWN uses the upper and lower limits to find an appropriate instruction for a calculated dose If you inadvertently miss one or more instructions out of a regime and the upper and lower limits of the instructions either side of the missing ones could be set too wide and a patient could potentially get an instruction that results in a dose that is significantly larger or smaller than intended for example in this case a patient with an intended dose of 11 2 mg per day would be instructed to take 1mg every day while a patient with an intended dose of 2 mg per day would be instructed to take 2 mg per day To guard against this DAWN AC uses the MaxlnstructionDoselncrement value to cap the upper and lower limits for each instruction by ensuring an upper or lower limit can be no more than half the Maxinstructio
243. le for use by the relevant departments Ensure all events have been defined correctly in the Event look up table and have been made available for use by the relevant departments 2014 Dawn Version 7 E Manual Ensure all letters have been defined correctly via message templates and have been set up to be created on the appropriate message events Safety Check List for Defining Look Up Information Ensure all information defined in the system look up tables has been entered and checked for correctness Safety Check List for List View Settings Check that all the required list views have been set up correctly and are available for use For each list view check that the correct fields are displayed For each list view check that each filter brings up the correct patients and that no patients meeting the criteria are missing For each list view make sure that users are aware of the correct filters to apply to select the correct subset of patients Safety Check List for Reports Ensure all new altered and imported reports have been thoroughly tested before using them in a live situation Check that all the required reports have been defined and are available for use For each report check that the correct fields are included in the report For each report check that the correct data is being generated Safety Check List for Custom Modules If you have purchased and are using any custom modules Ensure all new al
244. letters messages sent out from the system This should be carried out for all available methods of communication including printed output letters labels emails and faxes To prevent the wrong information being communicated to a patient or healthcare professional include the clear patient identifiers in any printed output emails and faxes e g dose instructions To prevent the wrong dose instruction being communicated to a patient include the current test date alongside the dose instruction Where printing user letters messages for a group of patients have a tally of the number of user letters you expect to produce and match that to the number of user letters actually produced to avoid missing anyone out Safety Check List for Adding Editing Deleting Patient Questionnaires If you have purchased and are using the questionnaire module Ensure all new altered and imported questionnaire types have been checked for correctness and have been thoroughly tested before using them in a live situation When completing a patient questionnaire check all the captured information is correct before saving or printing it System Manager s Check List 2014 Safety Section Safety Check List for Dose Interval settings and Dose Instruction Formats Regimes Check all regimes have been set up and checked for correctness and clarity Validate the dosage tablet instructions on set up or on changing Target Ranges Check all target ranges
245. lifying Risk Factors for non VKA For some anticoagulants it may be important to note which reason s or thrombotic risks have caused the patient to be prescribed this anticoagulant If no Qualifying Risk Factors are added no opportunity to record these risk factors will be provided on an Initiation Questionnaire For example for Dabigatran in AF patients the following risk factors may contribute to the decision to prescribe Dabigatran a38 Dawn Version 7 E Manual Qualifying Risk Factors 21 1 3 Risk Therapeutic Indication Dabigatran Atrial fibrillation nonvalvular Aged gt 65 with diabetes mellitus coronary artery d ER Dabigatran Atrial fibrillation nonvalvular Aged 75 over i Dabigatran AFNR Atrial fibrillation nonvalvular Left ventricular ejection fraction lt 40 4 fh Dabigatran AFNR Atrial fibrillation nonvalvular fhe Dabigatran AFNR Atrial fibrillation nonvalvular Symptomatic heart failure gt NYHA Class 2 Previous Stroke transient ischemic attack or systemic 7 The entries on this table link a Therapeutic indication and a Risk and you should ensure that the Risk chosen is marked In Use Lookup tables Anticoagulation Tables e Allergy BloodGroup Diagnosis Lookup tables e Drug Anticoagulation Tables DrugInteraction TargetRange INR EthnicOrigin Anticoagulant Event Regime Tw
246. list view in place of the image in the Alt Text field 7 TabletSize Caption and AltText are required fields You cannot save a record without a value in each of these fields 8 Choose the Browse button beside the Image field A windows Open File dialog is displayed 9 Search for the image file you wish to use to depict the tablet and choose Open The image is uploaded into DAWN AC 10 The image must be one of the following file types GIF JPG PNG 2014 25 4 2 25 4 2 1 2014 Anticoagulants Dosing Regimes and Instructions warfarin 11 The maximum size of the uploaded file is limited to 25 kilobytes 12 If the Tablet strength record applies to a particular brand choose the brand from the drop down list of existing AC brands 13 Optionally enter any notes concerning the Tablet strength record These are only visible in the setup form but can be included in list views message templates or reports Regimes and Instructions 1 Adosing regime is a set of dosing instructions spanning every possible dose for a particular anticoagulant and describing how to a achieve the dose with a particular tablet or combination of tablets 2 You can define different regimes for different brands and different tablet strengths e g Coumadin 5mg Tablets Jantoven 5mg Tablets Coumadin 1mg Tablets and Jantoven 1mg Tablets 3 You can define regimes for combinations of up to 3 different tablet strengths 4 You can define r
247. ll display the VGR_DisplayVGR system setting record Change the number in the Value field for the VGR_DisplayVGR system setting record to 1 to enable the VGR functionality or to 0 to disable the functionality 4 Click the Save button to save the change This system setting controls both display of the VGR indicator fields on the Patient Details screen and whether or not the values are calculated and stored in the database It should therefore be noted that turning the VGR functionality off for a period and then re enabling it will create a gap in the history of the VGR values calculated and stored in the database Use of VGR Values in Letters It is possible to use the current TIR and VGR range descriptions which apply for a patient in message templates so that for example a letter to a GP could include the text to say that a patient has an Above Average Percentage Time in Range and an Average VGR 2014 Variance Growth Rate VGR 4 Please contact 45 Information Systems if you require letters which include this information VGR Setup The VGR Setup screen is available on the System sub menu of the Management menu on the System Menu Changes to the values on this screen can only be made by 45 Information Systems staff who will enter a password in the field at the top of the screen to enable data HINT changes to be saved Users may use this screen to view the settings This screen is used to define t
248. lnits Current location For printing Select location DrugMedium a Drug olume nits Active Patients B Patierr 2014 52 Dawn Version 7 E Manual 9 2 4 List of Organisation Types Description feet St GP Practice fe Practices St laboratory flaboratories St Nursing Home oftware vendor Boftware vendors 2014 Settings for DAWN 53 9 2 2 Adding a New Organisation Type InUse pa sns see mua ql ar COM Bg Tou can add l JE ea Lo 9 3 Adding a New Organisation Different organisations can be set up within the system so that healthcare professionals and clinics can belong to a particular organisation You must have a Health Authority set up within the system before creating a new Organisation 2014 Dawn Version 7 E Manual LicenseAgreement Welcome License MaxActivePatientlount Frontpage Normal Tables Healthauthority i Organisation risus ward organisatio HCProFessianal Clinic Patientsroup LoginlLog Clinic diary Meeting MeetingTemplate e Jest ReferenceR ange e estaroup Therapy Template e Trial DrugTemplate OuestionnaireTvpe General ookupcateqorv e Team Lookup tables Reports fanannaman
249. lowed for this patient s treatment plan a red question mark appears beside the dose which you need to acknowledge before you can change the dosing instruction further Check each instruction changes as you would expect and that the average daily or total weekly dose for each instruction is correct Setting up LMWH and Pentasaccharide Agents Bridging VKA therapy with LMWH may be recorded on DAWN AC by setting up the following settings Please contact support 4s dawn com to get some example settings installed For heparin bridging doses see Scenario Bridging Therapy 1 Choose Lookup Tables LMW HDrug to display the Lookup Table which holds the master list of LMWH and Pentasaccharide anticoagulants 2014 Anticoagulants Dosing Regimes and Instructions warfarin 329 LMWHdrug eu Search for Name 777070070 Dsnaeme Name DisplayName DoseUnits Dose per Kg Mindose Max dose OrderNr InUse EEG Eneepen 5 EB Datepain en fs Eso ex Ju s eee ooo ju iu gt di l CCU 2 Press the orange New button to add a new LMWHDrug The LMWHDrug form is displayed LMWHdrug New record Name Display Mame DoseliniEs Dose per Kg Min dose Max dose Dose LMWHdrugSyringe Size nu will need to save this new record before vau can add related records LMWHdrugRegime Will need to save this new record before you can add r
250. lowing sections give some tips on creating and validating new dosing regimes 2014 3 Dawn Version 7 E Manual 25 4 2 8 1 Creating Dosing Instructions Define instructions for dosing regimes using a repeating pattern to increment each successive instruction in a uniform way There are two common approaches to this e Same Dose Daily e Minimum Increments The Same Dose Daily ensures the patient takes the same number of tablets on each day of the week reducing the possibility of the patient getting confused and taking the wrong dose This approach results in relatively large increments between dosing instructions and so is usually employed only on regimes which include the minimum tablet size available for the anticoagulant The Same Dose Daily pattern simply increments the dose for each day of each new instruction by the minimum permissible tablet part of the smallest tablet strength For example if the smallest tablet strength is 1mg and the minimum permissible tablet part is half a tablet instructions would be defined as follows Sun Mon Wed Thu Fri Sat 1 1 1 1 1 1 1 1 1 1 gt 1 2 1 1 1 2 2 2 2 2 2 2 2 Vo 2 Vo 2 Vo 2 Vo 2 Vo 2 Vo 2 Vo 3 3 3 3 3 3 3 3 3 3 3 3 3 3 etc The Minimum Increments approach allows much smaller increments between dosing instructions by incrementing the dose for one day at a time for each successive instruction by the smallest permissible tablet part of the smallest Tablet strength Th
251. lues are calculated each time a new INR is accepted and are stored in the database against the Treatment Plan and each Treatment record so that a history of values over time will build up for a patient if the functionality is enabled X Note though that when historical records are added or deleted the VGR figures on 7 subsequent Treatment records will not be recalculated HINT Where no value can be calculated for a patient because there not enough INRs recorded for them in the period then instead of a coloured box the text Not Calculated in grey will be displayed 2014 462 Dawn Version 7 E Manual Do not use the Percentage Time in Range and VGH figures in isolation to make any clinical decisions Ensure that you have a procedure to handle below average eTIR scores Enabling the VGR Functionality By default the VGR functionality is disabled when version 7 9 33 or later of DAWN AC is installed This means that by default the VGR fields will not be visible on the Patient Details screen and the values will not be calculated and stored in the database To enable the functionality a System Setting called VGR_DisplayVGR must be set to have value 1 as follows 1 Open the System Settings screen This is on the System sub menu of the Management menu available from the System Menu 2 Enter VGR in the Search For Name field at the top of the screen and click the search button This wi
252. lways displayed with the caption NHS Number regardless of any entry in the PatientNationalNo FieldCaption system setting A drop down list is displayed for NHS Number status For a full explanation of these fields their defaults interactions and the validation and reformatting that takes place on entering an NHS number see kkk Changes to the Patient Screen when you Enforce Compliance Which describes the same fields as they appear on the Personal Details tab of the main patient screen 2014 Enforcing Mandatory Use of the NHS Number 4 28 5 Changes to the Patient Search Screen When you switch on either level of mandatory NHS number compliance DAWN makes small changes to the patient search screen Selection Active patients Patients with active Treatment Plans for selected app area Show all C Search for Last name First name MRN 5 0123456789 012 345 Dateofbirth DoD Language Status All Next of kin name E Next of kin Mob phone 1 Verified Dateofbirth Address Address 2 Town County Post Code Sex Status Home phone Mobile phone STEPHENSON Hedley 70 H672563 012 345 6789 v 01 07 1942 57 Woodman Cottages Colliery Row Towbank Co Durham NR56 8H Male Active 01912 678 3678 0777 8889656 e he National Number is always displayed with the caption NHS No regardless of any entry in the PatientNationalNo FieldCaption system
253. me Notes PrintablePatientMessage Mail MergeType DescriptionTemplate PrinterPaperT ype 9 24 Adding Editing a Message Event Message events can be created so that messages can be automatically printed faxed emailed or sent to a phone list when certain actions are carried out within the system Please test messaging settings carefully before using with real patient data 2014 Settings for DAWN AC 12 LicenseAgreement Welcome License MaxActivePatientiount ic Frontpage 5 Normal Tables ic Lookup tables Reports 5 Management Clinic View settings MessageManagement MessageTemplate MessageEvent Fou are lagged an Sunport 45 wih user profile Tan Grade DAWN 227 JA 1 N FRAMEWORK Anticaaqulati Patient view Ca Add edit ar dose a patient E3Printin i List view Daily routines Reports Attendance and non attendance Parameter Report Diary Polar Reporting Consult the diary Audit amp security E3DawnInterface 5 System CodedComment Message center Manage messages and pass messages bw phone Reports Custom reports Settings Modify your personal settings 2014 1 Dawn Version 7 E Manual 9 24 1 List of Message Events MessageEvent EventType Template Patient message Eg 5 Dose Letter Patient ManualMessage bul Dose Letter
254. me In Range The TIR field calculation is the number of days that the patient s INR was within the target range for the patient as a percentage of the total number of days in the period for the last six months The value is calculated to 1 decimal place The calculation is only carried out where the patient has at least the number of non zero INRs recorded in the 6 month period specified on the VGR setup screen This number defaults to 2 2014 460 Dawn Version 7 E Manual VGR The VGR field calculation is based on the INRs recorded for the patient in the three months back from the last recorded INR It is calculated using the formula known as the Fihn Variance Growth Rate Method A The calculation reflects the degree to which a patient s INR deviates from his or her target INR over a period Using this formula a patient is considered most stable and therefore at lowest risk of an event when their INRs stay close to the target INR The formula used to calculate the VGH is 145 INR target A n the number of non zero INRs for the patient which fall within the 3 month period from the last recorded INR target the middle of the latest patient target range i e 2 5 for range of 2 0 3 0 the time in weeks between the current INR measurement and the previous INR measurement as a decimal Zero INRs are ignored in the calculation NOTE The target range used in the calculation is the
255. messages by phone Severity Type RiskClass Reports Custom repo rts Soplicationorea Diagnosisiroup DiagnosisStage amp Discipline MeetingTvpe DrugDoseUnits Current location For printing Select a location Dru gburationLlniEs Settings Modify your personal settings 2014 Settings for DAWN 115 9 19 1 List of Diagnosis Groups DiagnosisGroup Search for Name O a 2014 e Dawn Version 7 E Manual 9 19 2 Adding a New Diagnosis Group DiagnosisGroup New record Mame DrderNr Diagnosis 9 20 Adding Editing Diagnosis Stages If you need to add a diagnosis stage for a diagnosis that does not exist in the standard list new diagnosis stages can be added here 2014 Settings for DAWN AC 2014 License amp greement License MaxActivePatientCount L3 Frontpage Normal Tables Lookup tables Anticoagulation Tables e Allergy GloodGroup Diagnosis Crug Cruginteraction EthnicOrigin e Event HCProfessionalType amp JournalltemType LetterTemplate OrganisationT ype Procedure Risk Severity Severity Type RiskClass pplicationArea Diagnosisiroup DiagnosisStage Discipline Meeting ype e DrugDoseUnits e DrugDurationUnits Fou are commend FU Welcome fogged on Sun
256. min 2014 New Oral Anticoagulants non VKA Section 379 Cockcroft Gault estimate of CrCI 1 23 x 140 age years x weight kg x 0 85 if female Cockcroft D Gault MD Nephron 16 31 41 1976 serum creatinine pmol L Serum Creatinine 185 lumoVL High Body Weight 65 kg Gender Female Age at due date 38 dO mmn Moderate renal impairment Please be aware of the limitations of estimates of renal function in relation to muscle mass race and diet Hepatic Impairment Liver Enzymes gt 2ULN Other Blood Checks x Contraindicated Drugs CICLOSPORIN IRACONAZOLE KETOCONAZOLE TACROLIMUS 2014 Dawn Version 7 E Manual Interacting Drugs AMIODARONE CLOPIDOGREL ASPIRIN CLARITHROM Y CIN CLOPIDOGREL DICLOFENAC IBUPROFEN KETOPROFEN NAPROSYN QUINIDINE VERAPAMIL mimm mimm Other anticoagulant platelet apcmimab inhibitor ES S me Eptifibatide Heparin Prasugrel Sinthrome Ticagrelor Warfarin Other If other please give details If switching from is the INR 27 2014 New Oral Anticoagulants non VKA Section X Other contraindications Active clinically significant bleeding Hepatic impairment liver dizease expected to have any impact on survival Hypersensitivity to dabigatran etexilate Hypersensitivity to sunset yellow E110
257. mises the instruction so that it starts on the correct day and only includes the days until the next planned test If you deviate from the induction algorithm rules when dosing a patient either by overriding the dose or next test then you will have to manually dose the patient from then on When you authorise a patient s dose on the last day of the induction protocol the system displays an Induction to Maintenance Transfer dialog Induction to Maintenance Transfer Q Name Smith Josie 01 12 1956 This patient has reached the Final day of the Induction Algorithm veu wish ta transfer the patient to Maintenance Therapy AN Stability Check Induction Settings Last Dose 5 00 of tests ha Last Dose But 1 5 00 Last Dased on Dav 8 Difference 0 00 Dosing Regime WarFarin 1mg Whole Tablets in Daily Avgi Induction Algorithm TAIT ET AL INDUCTION u gt To Transfer the Patient to Maintenance Dosing please confirm the Following Maintenance Settings are correct and choose Transfer Maintenance Settings Dosing Regime WarFarin img Whole Tablets fin Mg Daily Avg Target INR Range 2 0 3 002 5 Target MaxPercentDosechange MaxInterval Inpatient This screen gives an overview of the induction settings used as well as a stability check between the current and last dose At this point check the stability figures carefully and change the patient s dosing 2014 26
258. n 345 Selecting Tablet Strengths and Activating your Regimes eere nennen nennen nennen 349 Switching off Compatibility 2 22 nins ac cub ea 351 Updating your Message Templates 1 21 222 1 111111111111 11111111113 rra 353 2014 20 Dawn Version 7 E Manual Permitting Users to Customise Instructions 354 T nm 354 Scenario Bridging Therapy ss 354 Scenario Handling Doses that Fall the Next Week 1 eene ennn nennen nennen 357 359 Part XXVI Frequently Asked Anticoagulation Questions 363 1 HOW Do TL Undo DOSE Z isores er cuc obe e EA o ida 363 2 Rescheduling a Patient s Next 22 2 2 366 3 Changing Patients CIInIG eiie ooo ee exp oca ER ce Dew En Env op ae e Sein ER 368 4 Managing Maintenance Induction Bridging 1 369 Part XXVI
259. n Dosing warfarin Same Dose Daily 1 3 general use Same Dose Daily Regime expressed in 1 3 and 5mg amp 5mg Tablets Tablets By default this regime uses UK Tablet images but you can change these to any brand you like see the section Setting Up Dosing Regimes and Instructions Regimes and Instructions Creating a Dosing Regime for full details on how to do this However if you upgraded from an earlier version or do not have these regimes for any other reason you can download and import them by performing the following steps please note you must have internet access 1 Call the 45 team on 44 0 15395 63091 for some ftp site details 2 Copy and Paste the nduction DosingHegimes xml file from the ftp site to a folder on your PC 3 Open DAWN AC and press F5 to display the system menu 4 Choose Management System DataExchange to display the DataExchange form and select the Import tab 2014 Anticoagulants Dosing Regimes and Instructions warfarin 259 Polar DataExchange Please give the File to import Upload Browse 5 Press the Browse button and select the nduction DosingHegimes xml file you have just downloaded then press the Upload button The list of AC Brands is displayed 6 Ensure the all the Default Import Policy checkboxes in the top right hand corner are selected Default impark palicy Import Update existing Selected records X Required records x x Automati
260. n Version 7 E Manual 24 24 1 Managing Patients Under Different Therapies Within DAWN there are three types of treatment plan therapy available for a patient on warfarin or other vitamin K antagonists 1 Induction on Warfarin or other vitamin K antagonists 2 Maintenance on Warfarin or other vitamin K antagonists 3 Manual Bridging dosing on Warfarin or other vitamin antagonists with LMWH Click on each section to read more about how each therapy works Additionally other therapies may be recorded within DAWN AC New Oral Anticoagulants Dabigatran Rivaroxaban etc Induction Dosing Induction therapy is used to start or restart a patient on warfarin and tries to determine an appropriate maintenance dose using established protocols Induction is an optional module If you have the induction module you can start a patient on induction therapy by selecting the options shown below when you create or edit their treatment plan _ n order for the induction algorithm rules to work the treatment plan start date must be day 1 af the algorithm ie the next visit for the patient and the treatment plan start date must match If they do not match DAWN forces the user ta manually dose the patient while in induction made zn in weeks active Choose induction therapy fram this Scroll down menu ACTherapy Disease area Choose dosing regime 3 AORTIC VALVE REP P
261. n a placeholder such as NK However once you enable either level of NHS number compliance you are prevented from saving an NHS number that fails the validation checks which means you have to enter a valid number or leave the field blank If you make the NHS number the mandatory patient identifier you remove the option to leave it blank and fill it in later which means you cannot add a patient unless you have their NHS number This setting is the same as the PatientUnitOrNationalNumber setting under System oettings they are two views of the same setting so changing it in one place inextricably changes it in the other 6 Click OK to apply your changes 448 Dawn Version 7 E Manual 28 3 Changes to the Patient Screen when you Enforce Compliance When you switch on either level of mandatory NHS number compliance DAWN makes small changes to the patient screen Personal Details Tab O E hopar i a LET Timstory nent plar thorn 5 Last name First name Hg Home phone ABE Ex Mobile phone Work phone NHSNumber g Email address h stephenson 78 amp hotmail co NHS Number status Trace required u T Address 57 Woodman Cottages RUNE H Address 2 Post Code 56 8HJ Sex Male Title Dateofbirth Ethnic origin Caucasian Language None selected Status Active If either level of mandatory NHS
262. n n n nnn nnn 73 Adding Healthcare Professional Account Info 74 Adding Healthcare Professional Password eese eene n enhn n nnn nnn nnn nnn nnn n nnn n nnn n nnn n nnn n nnn 75 9 HOS eru PU EUER 75 New Team FOR E 77 Choosing a New Team Organisationerna sni Co de 78 Adding a NeW TE dN 2 aa 79 ListView Team Filtet a aAA EA EAEAN EA an 80 10 Personal Setuligs scra a a 80 Personal Settings evo a et Dot E aa 81 11 Adding NeW GIIDIO rae ERE oe aa S ra E ERI E PSP SEEN 82 ST M 83 Adding Glinic De alls bdo e IDEE MI LA D DEM D DM E E 84 AGGING SIOU TEM Plate S 85 New SIOU Template e 86 Saved Slot Template 87 Clinic Adjustment OK IM 88 Saved Clinic Adjustment M
263. n the Initiation Questionnaire and shown on the Questionnaires tab summary comment Pop ups will also highlight contraindications on attempting to proceed with a plan for Dabigatran X Contraindicated Drugs Questionnaire screen shows a red X Summary shows contraindicated Dabigatran Initiation 29 08 Pop up warning example Please check the Init contraindicated for t The settings for contraindications may be updated as new medical evidence emerges using the Look Up Tables in DAWN AC 2014 Dawn Version 7 E Manual back to Help page 27 1 4 2 Renal function Guidelines recommend using an estimate of creatinine clearance rather than an eGFR calculation when dealing with patients on Dabigatran anticoagulation DAWN AC provides a calculator for estimating renal function from serum creatinine and body weight Cockcroft Gault estimate of CrCI 1 23 140 age years x weight kg x 0 85 if female Cockcroft D Gault MD Nephron serum creatinine pmolL 16 31 41 1976 Serum Creatinine i C ew umolL High Body Weight 59 kg Gender Female Age at due date 70 2f mL min Contraindicated severe renal impairment Please be aware of the limitations of estimates of renal function in relation to muscle mass race and diet back to Help page 27 1 4 3 Warnings on inconsistency and completeness Warnings are shown in red on the Dabigatran Initiation Questionnaire for age mild r
264. nDoselncrement from the average or total dose e g Jos his 2 2 en 2 iam es 25 280 _ 2014 292 Dawn Version 7 E Manual As the upper and lower limits have been capped this regime now contains no instructions for average daily doses between 1 25 and and 2 25 When you activate a regime DAWN AC checks for such missing instructions and prevents you from activating the regime if it finds any See section Activating Deactivating and Maintaining Regimes Activating a Regime Validation Checks Missing Instructions Please Note the default settings and rule of thumb described earlier are not appropriate for all regimes If you wish to make instructions for larger doses increment in larger steps than instructions for smaller doses for example for doses between 1 and 3 mg per day Average Dose Average Lower Limit Upper Limit Dose 18 75 19 25 you need to set the Max Dose Settings to reflect the largest intended step in this example 1 mg per Day so that the larger dose increments are permitted and the Lower Limits and Upper Limits for the larger doses look like this Dose 150 1440 1550 2014 Anticoagulants Dosing Regimes and Instructions warfarin 293 25 4 2 1 5 Setting Defaults for New Instructions 25 4 2 2 2014 MaxiInstructionDoseiIncrement 1 5 Defaults for new instructions DayPattern Line 1 default Sat Sun Mon Tu
265. nd New record Name AnticoagulantTablet nu will need bo save this new record before you can add related records Regime ou will need bo save this new record before vou can add related records 2 Enter the name of the brand in Name field This may be an actual brand name such as Coumadin or a generic description for a region where all tablet strengths colours and shapes are consistent for example UK generic If you try to save the record without typing a name in the Name field a message box informs you that the Description is required and you are returned to the form with the Name field highlighted 3 Optionally enter a display name for the Brand The display name is the name of the anticoagulant as it appears on a formatted dosing instruction for example warfarin or Coumadin If you leave the Display Name blank the anticoagulant name is used on the dosing instruction 2014 Anticoagulants Dosing Regimes and Instructions warfarin 25 4 1 3 Tablet Strengths Anticoagulant Warfarin Fhenindione Acenacaurmaral Phenpracouman Fluindione Bishydroxycoumarin gt Description Warfarin Motes 52 DoseUnits mg Tablets record 1 50 J 52 2 Caption Barr USA Warfarin Pills 1 mg Pink Pille 2 mg Lavender X Pills 2 m Green Filz 3 mg Brown x Pills 4 Blue x Pils 5 Peach Pilz 6 mg Blue
266. ndication Atrial fibrillation nanvalvular Duration of use Indefinite Age at due date Br Dabigatran Dose Dabigatran 150 mg twice daily The questions cover compliance issues patient questions and reasons for compliance issues adverse events renal function including a calculator for Cockcroft Gault estimate of CrCI records for liver function or other tests Contraindicated or Interacting drugs including other anticoagulants or platelet inhibitors Contraindicated conditions and Haemorrhagic Risks records for CHA2DS2VASc HASBLED scores notes for planned procedures or other comments 2014 New Oral Anticoagulants non VKA Section Once you have answered all questions click on Mark as complete and then schedule another Follow Up for your patient See details of the Follow up Questionnaire section 4 3 1 and section 4 3 ce a If you cannot answer some questions simply click OK or Save and come back later to complete the answers Mark as complete On marking the answers as complete you are confirming that DAWN AC can store this record display a summary on the questionnaires tab and check details against the treatment plan If you ve added some details in error Cancel your changes using or the rewind button at the top of the screen If you need to delete a questionnaire completely look for the bin symbol on the questionnaires tab and save before confirmi
267. ned in the Look Up Tables on your DAWN AC database Updates to the advice or additional drugs may be added to this list as required Please contact your system administrator to add new drug settings to the Interacting Drugs table back to Complete a Follow up page 27 2 3 2 8 Other anticoagulant or platelet inhibitor It is important to record any other anticoagulant or platelet inhibitor prescribed along with Dabigatran even if this for a short period 2014 New Oral Anticoagulants non VKA Section 45 Other anticoagulant or platelet inhibitor Eptifibatide Heparin Prasugrel sinthrome Ticagrelor z Warfarin Other If other please give details to continue 1mg per day until Friday 21st The list of drugs displayed may be added to or edited in the General Lookup Category for Anticoagulant or Platelet Inhibitors please contact your system administrator to arrange changes to the displayed options back to Complete a Follow up page 27 2 3 2 9 Other contraindications Please tick any of the other contraindications which apply to your patient These risks are identified in prescribing guidelines as contraindications for dosing with Dabigatran linically significant bleeding Hepatic impairment or Iver disease expected to have any impact on survival Other contraindications E m Hypersensitivity to dabigatran etexilate Hypersensitivity to sunset yellow E1
268. ng the record until you correct the order 2014 Anticoagulants Dosing Regimes and Instructions warfarin Description WARFARIN 6 MG WEEKLY DO CodeName WAREW Clone InUse Status In Maintenance 772272772 Anticoagulant Warfarin Brand 5 Generic warfarin DailyWeekly DoseUnits Mixed Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine E TE Pills 6 mg Blue Green USA Tablet 2 Tablet 3 Instruction record 1 50 f 70 2 1 5 4 5 3 00 45 7 5 7 5 10 5 9 00 10 5 las 12 00 Microsoft Internet Explorer Ias 15 5 15 00 15 5 19 5 16 00 las 225 21 10 22 5 255 24 00 2 ij Z5 27 00 Max step between instructions 3 ma per MaxiInstructionDoselIncrement 3 Defaults for new instructions DayPattern O ane tae foul part instr LE 2 Inpart instr inh 2 Impartinstr Tablets selected in wrong order In this case set the tablet strengths for Tablet 3 and Tablet 2 to none selected change the Tablet size for Tablet 1 to the smallest strength you wish to use then reselect Tablets 2 and 3 ensuring Tablet 3 is the largest 2014 304 Dawn Version 7 E Manual Description WARFARIN 6 MG WEEKLY CodeName WAR amp W Clone InUse Status In Maintenance 722271271 Anticoagulant warfarin Brand U5A Generic Warfarin Daily Weekly DoseUnits Mixed Tablets MinimumTablekPart Half a tablet
269. ng an instruction regardless of the Regime and oystem setting that determine whether it is displayed in the Dosing Panel 3 When you press Save the Avg or Total Dose Upper Limit Lower Limit Line1 and Line2 fields are all filled in automatically as described in the preceding section Creating DayPattern Instructions 25 4 2 2 3 Creating a Day Pattern Instruction in Mixed Strength Tablets Creating a DayPattern Instruction for Mixed Strength Tablets is the same as for single strength tablets except 1 The instruction displays a row of dose fields for each tablet strength used in the Regime You enter the number of tablets of each strength that are to be taken on each day 2014 2 Dawn Version 7 E Manual LowerLimit UpperLimit 1 25 AvgDose 1 rt instr Line In part instr Lined In part instr DayPattern artarin Wed Thu Sat Tablet img Tablet 3mg Tablet 5mg ed Pd part instr D px 2 Leave the dose field empty if the patient is to take no tablets of this strength on this day this is equivalent to entering zero 25 4 2 3 Creating Non DayPattern plain text instructions To create a purely textual instruction 1 Uncheck the DayPattern checkbox The individual dose fields for each day of the week are hidden and the four text fields are enabled Instruction Wartrin new regime LowerLinitUpperLimit Ave dose
270. ng you wish to delete this record Questionnaires Y mLDabigatran Follow Up 02 10 2012 Scheduled Dapigatran Follow Up 01 10 2012 Scheduled abigatran Initiation 07 09 2012 CrCL not recorded Dose 150 mg once daily E JQuestionnaireType Entry date If you need to add more information or adjust the Follow up Questionnaire which is already completed 1 locate the completed questionnaire on the Questionnaires tab 2 select Unlock to edit 3 save your changes NB unlocking a previous questionnaire to edit it may cause the details to be updated with subsequent changes to the patient details For example if the patient was previously on an 2014 4 Dawn Version 7 E Manual interacting drug which was later removed from your DAWN AC database the drug would still be stored in the old completed questionnaire On unlocking the old questionnaire the record for this drug may no longer be available back to Detailed Workflow page 2 2 3 2 1 Patient questions over past 2 w eeks It may be useful to record patient feedback on the following questions in the Dabigatran Follow Up Questionnaire Over the past two weeks have taken the correct dose every day might have taken too many capsules tablets might have missed one or more doses take more than 3 other medications regularly stomach upset burning pain 0 9 back to Complete a Follow up page 27 2 3 2 2 Reasons for
271. nge Date 20 07 2009 Y ET TELE Mon Fri Sak Sun 3 TETETEN As the average daily dose is updated each time Maggie change the dose for a particular day she can use this value to ensure she ends up with the same overall dose as before If Maggie used Weekly Regimes she would see a total weekly rather than an average daily dose A green edit icon denoting a minor edit appears beside the instruction in the patient s 2014 Anticoagulants Dosing Regimes and Instructions warfarin 301 treatment history so Maggie knows which instructions have been customised She can hover her mouse over the information icon to see the instruction for any date POE ME Tue Wed Thu Thu Fri Thu 09 07 2009 28 18 50 wi TE FAAA Aa sd od od od oq Fri 26 06 2009 2 4 50 00 ve Fri 15 05 2009 2 6 20 00 ve i B wk Tue 14 04 2009 2 6 21 00 ve ib Wied 06 04 2009 a l 21 00 ve i _ Tue OF 0402009 um 21 00 ve i Mon 6 042009 2 1 21 00 w dl The next time Maggie doses this patient so long as neither the dose nor regime have changed DAWN AC carries the customised instruction forward INR 2 5 InRange Date 27 07 2009 Y eo Not scheduled Mon Tue Wed Thu Fri Ta SE NU NE 415 415 415 415 Treatment notes dose change Dose W Status Tested Next 10 08 2009 2 wk dose p Personal Treatment plans
272. ngs RA Motes Vw PrintablePatientMessage MailMergeType PrinterPaperlT ype iNone selected RA DIY margin left 15mm pagetable width 183mm height 237mm margin Eap 47mm Jefttable width 8 1mm Fighttable width 101mm address padding left 8mm height vertical align top Fant Familv arial helvetica sans seriF Fant size 12 height 7mm vertical align center font family arial helvetica sans serif font size 12pth nhsna height 5mm verkical align center font family arial helvetica sans serif font size 10pt lastname height Smm vertical align center font family arial helvetica sans serif font size 12pt Firstname height 5mm vertical align center Fant Family arial helvetica sans seriF FonE size 12pt dab height 11mm vertical align top Font Family arial helvetica sans serif Font size 12pt historycorment 4heighk 4mm vertical align center Font Family arial helvetica sans serif font size Spt titleheight height 10mm vertical align center Font Family arial helvetica sans serif font size apt Date width 10mmifont Family arial helvetica sans serif font size Spt vertical align bottom Fou e etica sans serif font size vertical align bottom 2014 18 Dawn Version 7 E Manual 9 23 2 Adding a New Message Template Message Ml Na
273. nic diary screen will be presented You will then be able either to choose a different time Slot for the same day or click on another day block and choose a time slot for then by clicking on the Select button elect an appointment for GRAHAM EDNA 28 03 1931 Recomended date Wed 14 10 2009 ERAS Home Visi BANK ROAD HEALTH CENTRE e Diary date soos fi Sum 11 10 2009 Mon 12 10 2009 Tue 13 10 2009 Wed 14 10 2009 Thu 15 10 2004 Fril amp 10 2009 Sat 17 10 2009 oe 9600 96 600 96 9593 96 9600 96 9600 96 4 10 gt gt 1 145 24 2 4 df 438 2dj 29 amp 1d 1495 for Wed 14 10 2009 From intil Cap Left Reserved cap left 09 00 09 05 E 100 100 1 50 20 100 _ 25 7 100 ETE 100 9 50 09 55 100 100 100 TOH 100 wo O Select me ee ee Dawn Version 7 E Manual 26 3 Changing a Patients Clinic If the patient needs to be moved to a different clinic permanently then their Preferred Clinic can be changed on the top left of the patient screen before following the steps below pace Nace E i VALVULAR HEART DISEASE LINSPEC 2 5 3 5 3 0 Target Warfarin Mixed Tablets Daily 28 09 2009 7 In
274. nnaire section 6 3 39 Dawn Version 7 E Manual B Selection Active patients Patients with active OF Search for Last name Dateafbirth 22 Lastname Firstname Sex Mone selected L Dabigatran Initiation Mama Eric Lancastar Dar Jaca 7 sr e Status Scheduled Questions Sintus Scheduled Last ass complain TASTI 17 12 Darm Support Warfarin Mixed Tablets Weekhy Treatment Plan 4 1 ofi stopped cf drip ria Ta NL nu ho apanr surgery met ny E Da ip BREMI Sreski SEE Dm pm LED 2014 27 2 1 2014 New Oral Anticoagulants non VKA Section 397 7 See the FAQs page for some common queries on the Non VKA Workflow section 6 4 Don t forget to chase patients due for follow up at regular intervals you ll find them listed on the list view for Non VKA Y HINT At some time you may need to Change the dose of anticoagulant section 6 2 3 Switch to a different anticoagulant section 7 Stop the current anticoagulation record section 6 2 3 Mark the patient as inactive deceased In order to keep track of all your patients you will need to follow the daily weekly routines to check for patients overdue
275. nstr Line3default Tn nart incke r1 The ShowlnstructionTotalDoseLine setting determines whether instructions for the regime include an additional calculated Total mg line INR 2 1 InRange 7 Date 07 04 2008 Y Wed Thu An instruction in Tablets with an additional Total mg Line 2014 Anticoagulants Dosing Regimes and Instructions warfarin 285 There are three possible settings for this checkbox Greyed Use the default setting defined in the Showlnstruction TotalDoseLine system setting If this system setting is 0 the Total mg line is displayed for instructions which include tablet strengths of more than 1mg If the system setting is 1 the Total mg line is always displayed Unchecked Never display the Total mg line for instructions belonging to this regime Checked Always display the Total mg line for instructions belonging to this regime 6 The Max Step Between Instructions defaults to the Miniumum Tablet Part of the smallest tablet strength but you must choose whether instructions increment by this amount per Week or per Day As a general rule of thumb choose Per Week if your instructions allow different doses on different days e g 1 1 1 Per Day if all instructions stipulate the same dose every day e g Sun Tue Thu 1 1 1 1 1 1 1 V MUN Sat 1 1 1 1 1 1 1 However this rule of thum
276. nstruction and displays the following error 2014 350 Dawn Version 7 E Manual INF 2 4 InRange Date 09 07 2009 Y w5 Not scheduled ERROR The regime is currently not Active It cannot be used Treatment notes No dose change Dose Status Tested Next 20108672009 6 Mm Follow the instructions in Setting Up Regimes and Instructions Regimes and Instructions Creating a Dosing Regime to 1 Select the Tablet Strength used in the Regime 2 Ensure the Minimum Tablet Part is correct this defaults to Half a Tablet Ensure you change this to a Whole Tablet or Quarter of a Tablet where appropriate 3 Set the Max Step Between Instruction settings Once you have filled in this information 4 Follow the instructions in Setting Up Regimes and Instructions Regimes and Instructions Activating Deactivating and Maintaining Regimes to activate your regime DAWN AC prevents you from activating the regime before you have selected the tablet strengths or sizes and displays the follow messagebox 2014 Anticoagulants Dosing Regimes and Instructions warfarin 351 Description WARFARIN 2 5 MG WEEKLY O CodeName WARZEW InUse Xl Status Pe ERE ER Anticoagulant warfarin Brand V54 Generic Warfarin Daily Weekly CHE Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine Tablet 1 None selected Instruction record 1 50 70 2 UpperLinit 1 88
277. nt Press the edit button again to accept these terms and to edit the data 4 To accept these terms press OK and then press the Edit button again as directed in the message box The dosing regime form is unlocked 5 Press the Clone Regime button WARFARIN 2 5 Mi WEEKLY DOSE Weekly Meu l WARFARIN 3 MiG WEEKLY DOSE Weekly Active WARFARIN 4 MiG WEEKLY DOSE Weekly Active WARFARIN 5 WEEKLY DOSE Weekly Active WARFARIN B MG WEEKLY DOSE Weekly Active WARFARIN 7 5 WEEKLY DOSE Weekly Vvarfarin Induction rin Ma 1 Daily Awg Daily Active Vu AERE ARIA SM Active 52 Description WARFARIN 6 Ma WEEKLY DOSE CodeName WARKW InUse X Status Active E E NE Anticoagulant Warfarin Brand H5 Generic Warfarin Daily Weekly Weekly DoseUnits Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine Tablet 1 Pills 6 mg Blue Green USA Gen Instruction record 1 50 70 2 45 3 00 6 00 10 5 9 00 135 12 00 16 5 15 00 19 5 18 00 225 21 00 255 24 00 25 5 20 5 2r L0 step between instructions 3 mg Week MaxaxInstructionDoseIncrement E DayPattern Line 1 default In part instr Linezdefault In part instr Line3default In part instr Line4default In part instr A message box appears asking you to confirm you want to clone the regime 6 Press OK to clear the message box and press the Clone Regime button ag
278. ntains LMWH 4 Custom instructions never carry forward in Induction 25 3 13 Including Instructions in MessageTemplates 1 For backward compatibility existing Message Templates that include dosing instructions continue to display a plain text version of the dosing instruction without the need for any changes 2 Where DAWN AC is running in compatibility mode or where the instructions are Plain Text Non Day Pattern instructions the dosing instructions look exactly as they did in previous versions of DAWN AC 3 Where the Instructions are Day Pattern Instructions and DAWN AC is not running in Non Day Pattern the plain text instructions reflects the layout of the formatted HTML instructions warfarin Tue Wed Thu Fri Sat Sun labs X mg 22 58 32 3 34 Tabs 5 mg Total mg 3 3 3 3 3 3 4 It is possible to display the formatted HTML style instruction in your MessageTemplate instead of the Plain Text Version for example Take 0 00 for 2 days then Sun mon Tue wea mu Fa sat _ 2 2 2 2 Tablet 1mg e Tablet 5mg a a Total m g 2 2 2 215 2 714 7 however this requires a change to your MessageTemplates Please contact 4s DAWN support for help if you would like your message templates to display formatted HTML instructions Tel 44 0 15395 63091 support 4s DAWN com 2014 Anticoagulants Dosing Regimes and Instructions warfarin 263 25 3 14 Permitting or Prohibiting Custom Ins
279. ntiplatelet agent NSAIDS Alcohol Usage History 1 Procedures planned Comments Status scheduled Information in this questionnaire is used ta influence dosing and therapy decisions Please ensure all answers are accurate and complete back to the Questionnaires page Help to follow recommended guidelines In this section the software alerts and dose recommendations are explained DAWN AC has settings for drug specific contraindications and approved dosing regimes which are used within the patient treatment plan and questionnaire to help the user adhere to the chosen guideline The settings for risks warnings and contraindications may be updated so that every review of the patient s anticoagulation is fully informed from the latest guidance DAWN AC will highlight the following on the questionnaire screen 2014 New Oral Anticoagulants non VKA Section 389 Contraindicated concomitant drugs or conditions including impaired renal function section 5 4 1 and section 5 4 2 e Warnings on inconsistency and completeness based on advanced age section 5 4 4 Dose warnings on discrepancies in the recorded details section 5 4 4 The system also performs some validation checks and highlights any discrepancies when the user activates a new non VKA treatment plan section 5 4 5 click here to go back to Overview page back to FAQs page 27 1 4 1 Contraindications Contraindications are highlighted in RED o
280. o add new drug settings to the Interacting Drugs table back to Initiation Questionnaire page 2014 New Oral Anticoagulants non VKA Section 405 back to Interacting Drugs Settings page 27 2 1 2 7 Other anticoagulant or platelet inhibitor It is important to record any other anticoagulant or platelet inhibitor prescribed along with Dabigatran even if this for a short period Other anticoagulant or platelet E inhibitor EUN Eptifibatide Heparin Prasugrel sinthrome Ticagrelor Warfarin Other If other please give details to continue 1mg per day until Friday 21st The list of drugs displayed may be added to or edited in the General Lookup Category for Anticoagulant or Platelet Inhibitors please contact your system administrator to arrange changes to the displayed options back to Initiation Questionnaire page 27 2 1 2 8 Switching from VKA If your patient is switching from warfarin or other vitamin K antagonist to Dabigatran please check the latest INR result and tick the box if it is greater than 1 9 If switching from Delay starting dabigatran until IHR 2 is the INR gt 2 back to Initiation Questionnaire page 27 2 1 2 9 Other contraindications Please tick any of the other contraindications which apply to your patient These risks are identified in prescribing guidelines as contraindications for dosing with Dabigatran 2014 4 Dawn Ve
281. o display their full details Choose the Account tab and enter the user s Active Directory Network User ID in the NetworkName field HCProfessional PasswordExpirationDate Organisation Big Hospital T HCProfessionalType IT LastName Initials InUse Be User Yes Click to reset password Failed login count Locked Last login date 29 06 2009 1 Total number of logins 193 Failed login count total D UserProfile Top Grade NeEworkName Disabling Anonymous Access to the DAWN AC website 4 Right click on My Computer and choose Manage from the pop up context menu to display the Computer Management Console Expand the Services and Applications branch of the menu and click on nternet Information Services Expand the Web Sites folder right click on the Web Site which hosts DAWN AC and 2014 2014 Logging In Active Directory Support 173 choose Properties from the pop up context menu The web site properties are displayed 7 Choose the Directory Security page and click the Edit button in the Anonymous Access and Authentication section Tree qm iilis catal aciem ipa Eae nir ree eu Default Web Site Properties E Scripts ERES EH ub ind Web Site Uperators Performance Filters Home Directory Documents Directory Security HTTP Headers Custom Errors Server Extensions E s II55ample
282. o note This restriction only applies to standard instructions defined for a regime If you customise an instruction for a patient you can set the doses for different days to whatever you wish This allows you to stop or reduce warfarin prior to a surgical procedure and restart it with one or more loading doses following the procedure e g Sun Mon Thu Fri Sat 0 0 0 0 10 79 9 However if the doses for two or more days differ by more than the smallest unit DAWN AC logs this as a Major Edit and requires you to dose this patient manually the next time they attend This ensures DAWN AC never uses an inappropriate dosing instruction as the basis for a future maintenance dose See Also Working with Dosing Instructions Customising Dosing Instructions Working with Dosing Instructions Preventing dose calculations based on inappropriate doses DAWN checks that all tablets you have selected for the regime match your selected brand If you select the tablets for one brand then change the brand without reselecting the tablets the tablets pictures may be wrong for example New Activate Deactivate Warfarin Brand Coumadin USA Coumadin Tablets Half a tablet ShowlInstr Fa Pills 1 mg Pink Gantoven MinimumTabletPart In this case DAWN AC prevents you from activating the regime and alerts you to the discrepancy with the following message 2014 322 Dawn Version
283. oagulants for dose settings For heparin bridging doses see Scenario Bridging Therapy 25 4 1 3 1 Creating a Tablet Strength record 1 Select the Anticoagulant record you are creating the Tablet Strength for A list of existing tablet strengths is displayed in a list box on the anticoagulant record If the anticoagulant does not have any tablet strengths defined the empty list displays the words There are no items to display 2 Click the name of any existing Tablet strength record or the words There are no items to display to display the editable list of tablet strengths for this anticoagulant Any existing Tablet Strengths for this anticoagulant are displayed grouped by AC Brand 3 Click the orange New button at the foot of the form The new AnticoagulantTablet form is displayed 2014 276 Dawn Version 7 E Manual Tabletsize Inlise x 4 Enter the numeric TabletSize or strength e g 3 for 3 mg in the TabletSize field 5 Enter the Caption you wish to be display for this Tablet Strength in a formatted instruction for example Pills mg The caption must be clear and concise If your caption is too long the caption will word wrap INE 2 6 InRange Date 29 0 2009 F Warfarin Sun Mon Tue Wed Thu Fri Sat bills 10 10 nud An instruction with word wrapped captions 6 Enter Alternative text that can be used in a report or
284. omments Y Fri 12 10 2007 1 738 50wg 7d EEE Just stopped 2 interacting drugs and INR dropping Raised dose and w N Living with Warfarin education video and talk about concordance strob Fri 03 08 2007 2 1 35 00 1 To change the first day of the week for an instruction select the new day from the drop down list box for the first day in the instruction The Days of the week change so they start with the day you select 2014 Anticoagulants Dosing Regimes and Instructions warfarin 235 25 3 4 Leave Days Out of the Instruction INF 2 6 InRange Date 22 07 2009 Y v Sak Sun Tue W 44 5 Mon E Dose increased by 0 Dose 7 17 d Status Tested Next 12 08 2009 Accept dose Y Weed 22 07 2008 5000 8 ck Y Wed 08 07 2009 21 somwa 2wk Wed 0140712009 26 500048 Missedtabletsforlasttwo days Y Fri 26062009 24 5000 8 Y Fri 15 05 2009 2 6 20 00 wa B wk 4 14 04 2008 26 2100 wf Wed 0840472009 21 2100 wf 07 04 2008 27 21 00 Mon 06 04 2009 2 1 21 00 vv di 1 To remove one or more days from the instruction double click the name of the first day you wish to remove The selected day and all following days are removed from the instruction Removed days do not appear in the final instruction The days names appear in grey in the Editing Form so they can be reinstated
285. on Only amending or deleting look up and normal table settings after a backup has been taken This will help minimise the potential loss of data should you inadvertently delete the incorrect settings and need to restore your database Checking the hardware for possible errors especially the data disk storage Replacing backup media regularly media only has a set storage life Backing up routinely at appropriate intervals and test if you are able to restore the data and programs if required Ensuring your backup procedures are working and are appropriate for your database If your database recovery type is set to full ensure you are taking transaction log backups at regular intervals Ensuring backup media is stored safely in a separate place from the computer system and is readily referenced Providing adequate protection from power failures notebook laptop battery discharge and interruptions otaff inadvertently switching power off at the mains Checking for computer virus violation Documenting and reporting software and operational problems or near misses to DAWN Clinical Software and their own management Documenting all changes to system set up to show they are properly controlled and validated Routinely checking that the DAWN Mailer program is operational and working correctly 2014 Dawn Version 7 E Manual Ensure your procedures are complete i e no sections have been removed and are kept in a
286. on az forcing George with user prone Top Grade Normal Tables p Lookup tables Anticoagulation Tables AW N Allergy A i BloodGroup Anticoagulatior Diagnosis e Drug DrugInteraction Patient EthnicOrigin add edit or i Event HCProFessianalTvpe List view JournalltemType Attendance LetterTemplate OrganisatioanTvpe Diary Procedure Consult the Risk Severity Message i Severity Type Manage mes RiskClass Disease area Reports Diagnosisaroup Custom rep DiagnosisStage Discipline Settings ip Meeting Type E CrugDoseUnits DrugDburationlIniEs CrugMedium CrugVolumeUnits Frequency e warnLevel Y Bar logging an conditions oF 1 Current location For i VisitType nterventionTimeslot Inadequate LMWHdrug Check that all cli iedit Interruptions t brand 222 comuption Th increase check Readthe Safe Ceri essationR easa Language 2014 12 Dawn Version 7 E Manual 9 22 1 List of Languages Language Name CodeName int try dens p r 2014 Settings for DAWN 125 9 22 2 Adding New Language Language New record 5 codename Orderhr 9 23 Adding Editing a Message Template Letters and forms can be config
287. ons you can change the NHS number status by selecting the relevant option from a drop down list By default everyone who is permitted to edit patient records can change the NHS number status but your system administrator can remove this permission for certain groups of users If DAWN is interfaced with your Patient Administration System the NHS number and verification status can be added and updated automatically via the interface To comply strictly with the directive all electronic and hard copy output printed letters reports emails faxes and electronic interface updates that include patient demographic information should include the NHS number but only where it s verification status is 01 Number present and verified When full compliance is enforced DAWN automatically suppresses the NHS number on any letter report or outbound interface message where the verification status is not 01 Number present and verified Validate and Verify Only Compliance DAWN does include a half way house option between no compliance and full compliance This option called Validate and Verify Only applies the first three principles but not the fourth This is aimed primarily at sites upgrading from earlier versions of DAWN who have NHS numbers recorded for the majority of patients and already include the NHS number on letters reports or outbound interface messages When you upgrade the verification status for all existing NHS numbers defaults
288. ontact 45 DAWN Clinical Software for more information at sales 4s DAWN com support 4s 2014 374 Dawn Version 7 E Manual DAWN com 2 1 1 Non VKA list view DAWN Dabigatran module presents a list of patients for review today this week this month Each patient can have Initiation or Follow up questionnaires scheduled for future dates Black Bertha 32423452354 Mone Scheduled Bloogs Joe simpl click to see Mone Scheduled Clarke Cherise Mone Scheduled DavidLasti DavidFirst1 123789 record Mone Scheduled Horrible Horace 32423434 E Mone Scheduled Trouble Trevor 7324234234 Mone Scheduled Overdue Scheduled mea White Walter 23124234 02 07 2012 Dabigatran Follow Up Overdue dimi for this Morecambe Eric 9876542 31 08 2012Dabigatran Initiation Overdue patient 8 Stephenson Hedley 123456 05 09 2012 Dabigatran Follow Up Scheduled Scheduled Brewster Bobbie 3452352354235401 10 2012 Dabigatran Follow Up Scheduled Scheduled Complete Please note VTE patients treated wit it Ha ivaroxaban typically start on a twice daily dose White Walter Brewster Bobbie CrCl not recorded CrCl mL min 109 Black Bertha not recorded Horrible Horace 3242343434 Jere mL min 70 Trouble Trevor T324234234 CrCL notrecorded The list of patients may be filtered by date of next follow up clinic location risk class patient group dia
289. op down list of frequency options Dosing Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 12 10 2007 Y fates RAE Mon Sat Sun Mon Wed 17110 6 0 MEA Sat Sun Mon Tue Wed sun Mon Tue TTE 12 single amo 24h two amounts A second PM line of checkboxes for each day is displayed along with a PM time field The PM time fields defaults to 12 hours later than the first AM time 2014 Anticoagulants Dosing Regimes and Instructions warfarin m Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y estar x Sat Sun Tue Wed Thu MEN Fir Sun Mon Tue Wed Sat Sun Mon Wed Thu Sat Sun Mon Tue Wed wv LMWH 12h single amount Dose 1 33d dT 11 If you leave the PM time at its default value and change the AM time the PM time updates automatically If you change the PM time so that it is not 12 hours after the AM time a red exclamation mark is displayed beside it to highlight the difference Dosing cantacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y vx
290. ophageal Reflux Dizease Gastrointestinal Bleed Lack of information Lives alone Multiple medications Prescriptions from several doctors Anaemia Bruising Change in color of stools E E Epistaxis Haematoma Vomiting blood 2014 New Oral Anticoagulants non VKA Section 385 Measured Creatinine Clearance nm Cockcroft Gault estimate of CrCl 1 23 x 140 age years x weight kg x 0 85 if female Cockcroft D Gault MD Nephron serum creatinine pmol L 16 31 41 1976 Serum Creatinine umolL Low Body Weight kg Low Gender Age at due date 70 Calculate Cockcroft Gault CrCl mL min Please be aware of the limitations of estimates of renal function in relation to muscle mass race and diet Hepatic Impairment Liver Enzymes gt 2ULN 2014 396 Dawn Version 7 E Manual Contraindicated Drugs OSPORIN TRACONAZOLE KETOCONAZOLE TACROLIMUS 1 1 1 1 Interacting Drugs AMIODARONE ASPIRIN CLARITHROMYCIN CLOPIDOGREL DICLOFENAC IBUPROFEN KETOPROFEN NAPROSYN QUIN IDINE VERAPAMIL d 1 11 1 d Other anticoagulant ar platelet inhibitor Abciximab Eptifibatide Heparin Prasuqrel sinthrome Ticagrelor Warfarin Other INL NI ND I If other please give details 2014 Other contraindications Haemoarrhagic Risks
291. or Organisation HCPrafessianalType HCProfessionalType __ 5 E Dawn Clinical Software IT T ie eL on O emm 2014 Settings for DAWN 9 8 2 Adding Healthcare Professional Details Organisation LastName E he sts FirstName Initials InUse Address info Tile SationalNumber LocalNumber DirectTelephone Mobile Email DirectFax MessagingMethod 2014 Dawn Version 7 E Manual 9 8 3 Adding Healthcare Professional Account Info HCProfessional Initials InUse Fe User Last login date Total number of logins Organisation The Big Hospital HCProfessionalType Last name First name Click to create a new password for user PasswordExpirationDate Locked UserProfile 2014 Settings for DAWN AC 9 8 4 Adding Healthcare Professional Password 9 9 2014 HCProfessional Organisation The Big Hospital HCProfessionalType e Last name First name Initials InUse xi Account info User Click reset existing password for user PasswordExpirationDate Failed login count Failed login count total 0 Locked Last login date Total number of logins meee D Patient Message from webpage The password for user
292. orised The result date is before the treatment plan start date If you have a chronic disease monitoring test result interface also Result date is more than N days in the past where N is the Sample Date Warning Threshold for the relevant Test definition in DAWN Unrecognised test name Result date is in the future If you have a Demographic Next Appointment interface also The appointment date is too far in the past or future The patient has an existing appointment with a status of Tested or DoseSet and so their next appointment cannot be set The patient is deceased he diagnosis does not exist in DAWN An attempt was made to update a doctor to belong to a different organisation Multiple matches were found when identifying a doctor The Health Authority has not been set when adding a new organisation If you have an ADT interface also The patient is deceased patient has a Stopped treatment plan and the interface is configured to place ADT messages on hold in this situation he patient s treatment plan has a status that is incompatible with the ADT message for example an admission message is received for a patient who is already flagged as admitted An invalid admission discharge date time has been supplied 2 Test Result monitor displays test results processed by the chronic disease monitoring test result interface but which could not update the patient latest appoin
293. orrhagic risks or age renal function Q What is and Age alert Patient ages over 75 or 80 years will result in Age alert appearing on the non VKA list view where the dose of Dabigatran is unexpectedly high Scheduled Questionnaire status Nicol Test3 88888 80 12 09 2012 Age ALERT Scheduled Dpbigatran 220mg once daily Dabigatran Follow Up Scheduled Spade Sam 52492143 28 09 20 T2 5ch Dabigatran 110 mg twice daily Dabigatran Follow Up Scheduled White Wilma 23124234 57 30 10 2012 Scheduled Dabigatran 110 mg twice daily Dabigatran Follow Up Scheduled Jones Tom 9999999 80 31 10 2012 Scheduled Dabigatran 110 mg twice daily Dabigatran Follow Up Scheduled Q Dabigatran dose need to use isn t available on the DAWN AC screen Your DAWN AC settings may need to be updated by your system manager contact support 4s DAWN com for assistance Q Where is the INR warfarin history for my patient now View previous treatment plans using the black arrow on the patient screen and you ll see the History panel for any VKA episode of treatment Black Bertha 01 04 1974 324234523 Risk class Low Pref dinic Postal Clinic St Elsewhere home Age Atrial fibrillation nonvalvular 05 09 20121 Dabigatran 110 mg twice daily P of2 Mew back to Detailed Workflow page 2014 4 Dawn Version 7 E Manual 27 3 27 3 1 Changing Anticoagulant
294. osage instruction report is stuck in the correct patient s record book Check the correct dosing information is copied by hand to the correct book or patient report Check that all patients including non attendees due on a particular day have been dealt with completely Ensure you assess and take into account the stability of each and every non attendee before deciding on the date to reschedule their appointment for 2014 Dawn Version 7 E Manual Check that the wrong information is not communicated to a patient by letter telephone or any other communication method Routinely ensure that each patient has a maximum percentage dose change and maximum interval limits Routinely ensure that all active patients have a future appointment Routinely check that all patients that are marked as admitted active admitted or discharged within the system have been followed up and dealt with Safety Check List for Adding the Next Test Date Time Ensure that the patient has a next test date time and is scheduled into the Diary Use the list view to ensure that all active patients have a next test date Safety Check List for Adding Editing Deleting Letters Messages Ensure all new altered and imported letters message templates have been checked for correctness completeness clarity in all situations e g miss days boost days and have been thoroughly tested before using them in a live situation Check the correctness of all
295. ou have a regime where instructions for larger doses step up in bigger increments than those for smaller doses e g for doses between 1 and 3 mg per day but for doses between 15 and 19 mg per day 2014 Anticoagulants Dosing Regimes and Instructions warfarin ERR Dose Limit Limit as 5 8 48 18 16 15014751525 16 16 16 16 16 e 16 160 1575 1620 18 he meo 9 jm beo 8 _ you need to set the Max Dose Settings to reflect the largest intended step in this example 1 mg per Day so that the larger dose increments are permitted and the Lower Limits and Upper Limits for the larger doses look like this Tue Wed Thu Average Lower Upper Tc m 45 150 4450 TE N33 m RE RA NM mom 90 900 es _ 18 18 6 18 18 180 1750 _ See Also Regimes and Instructions Creating a Dosing Regime Setting the Max Step Between Instructions DAWN checks each instruction to ensure the dose for one day does not exceed the dose for any other day by more than the smallest tablet part of the smallest tablet For example 2014 32 Dawn Version 7 E Manual LowerLimit 1 46 UpperLimit avg dose Line 1 Sun Mon Tue Wed Thu Fri Sat part instr Line 2 2 15 1 15 1k In part instr Do Inpart instr O ics PY in part instr 0 DayPattern x Jantoven
296. ou have amended the discrepancy or clicked the red question mark to acknowledge the warning see illustration below Dosing Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 12 10 2007 Y esgic M Tue x3 Sun Mon Tue da Total mg None selected w Dose 2 254 Y Status Tested Next 7d Warning The instruction only covers period of 6 days Graph History Personal Treatment plans Ad Qua Therefore the next recommended appointment date is expected to be at 18 10 2007 Date INK Dose Time DNA In range Y Fri 12 10 2007 1718 50 7d Click this button to suppress this warning d dose and w Y Fri 28 09 2007 2931 500 22 Y Fri 14 09 2007 3 3 31 50 kl Fri 24 08 2007 3 0 35 00 w Living with Warfarin education video and talk about concordance stro Fri 10 08 2007 2 8 35 00 p i r Fri 13 08 2007 2 1 35 00 lil gt 5 If a customised instruction spans less than 7 days DAWN works out the average dose based on the days included in the instruction and stores this as the numeric dose If the patient is on a Weekly regime it is not possible to work out a weekly total so an average daily dose is substituted and the daily weekly flag on the particular treatment record is updated correspondingly so that DAWN AC knows how to interpret this dose
297. out to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again to accept these terms and to edit the data 3 To accept these terms press OK and then press the Edit button again as directed in the message box The edit dosing regime form is displayed Description Status Anticoagulant Brand Generic Warfarin Daily Weekly DoseUnits MinimumTabletPart Half tablet gt Tablet 1 Pills 1 mg Brown UK Generic t Instruction record 1 50 141 22 0 0 00 0 105 0 07 0 175 0 14 0 25 0 21 0 325 0 29 0 395 0 465 0588 MazxInstructionDoseIncrement 0 08 Defaults for new instructions DayPattern x pedis Pd part instr H peii D IX EE Pd part instr uper 2 JInpart instr O Clone Regime 4 Press the Activate button DAWN AC performs a number of validation checks to ensure the instructions in the regime are valid complete and contain no duplicates If your regime fails any of the validation checks a message box informs you of the problem and you are prevented from activating the regime until you have rectified it See section Activating Regime Validation Checks for full details of thes
298. p E LoginLog Clinic diary Fax 21 MeetingTemplate Organisation 2 e Test Bic Hospital ReferenceRange TestGroup TherapyTemplate Trial DrugTemplate QuestionnaireType GeneralLookupCategory Team CLookup tables Reports HealthAuthorityStaff here are no items to display Management InUse x E E m Le 9 2 Adding Editing Organisation Types 2 2 If you need to add a type for an organisation that does not exist in the standard list new types can be added here 2014 Settings for DAWN 51 License greement Welcome License MaxActivePatientCount Fou are coment beqed on Sunport 35 eth usar prone Top orade Fe paie tables D LN E M 1 Anticoagulation Tables 2 VV NO T 4 Allergy Anticoagulatj BloodGroup iticoagulati Diagnosis 2 i Patient view add edit or dose a patient EthnicOrigin Event HCProfessionalType __ JournalltemType here to add LetterTemplate OrganisationT ype Procedure List view Daily routines Attendance and non attendance Diary Consult the diary x Message center everity Manage messages and pass messages by phone Severity Type RiskClass an Reports Custom repo rts pplication rea Diagnosisaroup DiagnosisStage d Settings Discipline Modify your personal settings Meeting Type DrugDbasel
299. p tables Anticoagulation Tables TargetRange INR Regime Induction Algorithm ResultRange INR 1 Choose Lookup Tables Anticoagulation Tables Anticoagulant from the System Menu to access the Anticoagulant lookup table 2014 28 Dawn Version 7 E Manual Anticoagulant Description Motes DoseUnits Tablets Caption Fils 1 m Pille 2 mg Pills 22m Filz 3 mg Pille 4 mg Fils 5 mq Pilz B mg DrderNr inse Sarr USA Warfarin Warfarin Fhenindione Acenacaurmaral Phenproacouman Fluindione Bishydroxycoumarin gt Warfarin ud mg record 1 50 J 52 Pink Lavender Green Brown Blue Peach Blue Green 11111 JEA 12 d xr x 2 he Anticoagulant look up table holds a list of all the oral anticoagulants used in the different dosing regimes for example Phenindione warfarin and Sinthrome 3 Each Anticoagulant can have one or more dosing regimes A dosing regime is a set of instructions showing how to achieve any average daily or total weekly dose with a particular tablet strength or strengths 4 Once you have recorded doses for a patient using a particular dosing regime you can only change their dosing regime to another regime for the same anticoagulant This is because the doses of different anticoagulants such as warfarin and Phenindione are not directly equivalent To change a patient s anticoagulant stop their current treatment plan and
300. password must contain at least 1 special character e g 96 etc For example a password such as Tracy1 would meet these criteria Enter your new chosen password into the New Password and Confirm boxes before clicking 2014 Dawn Version 7 E Manual on the Login button wow Username Password If wou want to change your password please alsa fill the following two fields ewpassword seseesse Re type new password eeseeese 51997 2009 45 Information Systems Ltd 1 If your password change has been successful the system should log you into DAWN If you are unsuccessful a message should appear telling you why e g user name incorrect password incorrect You are allowed up to three attempts at logging into DAWN before a screen appears saying Login Denied Please contact your system administrator If this occurs you can close down all internet screens and try bringing up DAWN again to log in If you then unsuccessfully try to log into DAWN AC another two times which totals 5 attempts altogether then your user account will become locked and another user will need to log into DAWN to unlock it If all users are unable to log into the DAWN system there may be an issue with the DAWN system itself Please contact your IT department if this occurs 2014 7 Dawn Version 7 E Manual DAWN Front Page Patient view C Add edit or dose a patient L
301. please also fill the following two fields New 1997 2009 45 Information Systems Ltd LOGIN Li By logging on to this system you have been deeme B L i amings and conditions of use e Inadequate Checking af Dose and Next Test Date ik njury and death e heck that all therapy instructions are appropriate before instructing a patient Interruptians ta the operations ofthe software e g Power failure switching af can lead ta data corruption This could lead ta severe ar death Following any such interruption to operation increase checking vigilance Read the Safety Section in the User Manual e Ensure backup of your database using a multiple copy schedule e Bwvusing this software the useris bound by the terms ofthe Sofware Licence and Maintenance agreement and Customer Obligatic document 2014 4 Dawn Version 7 E Manual 8 2 Dawn Front Page rer prone Top Grade 1 N IC CAI Thu 18 06 2009 DAWN i version 7 9 1245 Anticoagulation Patient view Ca add edit or dose a patient List view Daily routines Attendance and non attendance gt Consult the diary Message center Manage Messages and pass messages by phone es Reports Custom reports Settings your personal settings Current location for printing Select a location Mo of Active Patients Patients on Treatment Mow Missed Test
302. port 35 with usar profile Top Grade Anticoaguilati Patient view C dd edit dose a patient List view Daily routines Attendance and nan attendance Diary Consult the diary Message center Manage Messages and pass messages bw phone Reports Custom reports Settings Modify your personal settings Current location For printing Select a location Dawn Version 7 E Manual 9 20 1 List of Diagnosis Stages DiagnosisStage joo e 1 Search for Name 7 umi by name in this search box gt RHEUMATIC HEART DISEASE 2 f i 2 oo od el 2014 Settings for DAWN owe 9 20 2 Adding a New Diagnosis Stage DiagnosisStage New record Diagnosis Name OrderNr InUse 9 21 Adding Editing WarnLevel If you need to add warn levels to drugs events etc that do not exist in the standard list new warn levels can be added here 2014 120 Dawn Version 7 E Manual DAWN o tables Anticoagulation Tables e Allergy GloodGroup Diagnosis e Crug Dru gInterackion EthnicOrigin Event HCProfessionalType JournalltemType LetterTemplate Organisation ype Procedure i Risk Severity Severity Type RiskClass pplication rea Diagnosisaroup DiagnosisStage Discipline Meeting Type DrugDoseUn
303. r PrinterPaperType in the message template e Press F5 to display the system menu and choose Management Printing MessageManagement MessageEvent e Edit the message event you are setting the Paper Type for MessageEvent EventT ype Template Patient message Eg S Dose Letter Patient_ManualMessage Dose Letter Written DNA Letter Patient Manuallessage vt DNA Letter a written DNA Discharge letter TreatmentPlan_OnPatientIsMonattending w DNA Letter written Ele Manual Dose Print Patient_ManualMessage ka Dose Letter 23 phane e Select the PrinterPaperType for the message event This will ensure that the selected printer will use the correct printer paper type when generating this message event 2014 Setting up Printing User Guide 16 Mone selected PrinterPaperType e Choose Save 2014 17 2014 Logging In Active Directory Support 171 Logging In Active Directory Support DAWN AC version 7 0 1010 and above supports Active Directory Login This means users who have a network login can store this ID in DAWN AC When they access the application if DAWN recognises their network ID it automatically logs them in without prompting them to type a DAWN AC specific user ID and password To enable Active Directory Support To enable Active Directory Support you need to perform the following steps 1 Enable Active Directory support
304. rTemplate Diary OrganisationT ype Consult the diary Procedure Risk Message center Severity Manage messages and pass messages by Severi Type RiskClass ila Reports Custom reports Spplication4rea Diagnosiziroup DiagnosisStage mc Settings 2014 Settings for DAWN AC 9 13 1 List of Patient Allergies Allergy 2014 098 Dawn Version 7 E Manual 9 13 2 Adding a New Patient Allergy Allergy New record InUse 1 the to the ele mE 9 14 Adding Editing Blood Groups If you need to add an blood group that does not exist in the standard list new blood groups can be added here 2014 Settings for DAWN AC 9 License greement Welcome License MaxActivePatientcount Fou are coment an ar Sunpart 45 Wilh wre prae Too Grade Frontpage Normal Tables i CLINICAL Lookup tables eee CLINICAL E3 Anticoagulation Tables RAMEWORK Allergy BloodGroup Diagnosis Drug Cruginteraction EthnicOrigin Event HCProfessionalType JournalltemType LetterTemplate Anticaai Patient view he add edit dose a patient List view Daily routines Attendance and non attendance Hem Diary Organisation Type Consult the diary Proced
305. rand None selected Daily Weekly DoseUnits Mg MinimumTabletPart Half a tablet v Tablet 1 selected Whole tablet Half a tablet Instruction here are items to display Quarter of tablet MaxiInstructionDoselIncrement 1 5 Defaults for new instructions DayPattern ub Pd In ppart instr Pd part instr 2 D D 0 0 0 part instr Clone Regime 6 The Max Step Between Instructions defaults to the Miniumum Tablet Part of the smallest tablet strength but you must choose whether instructions increment by this amount per Week or per Day As a general rule of thumb choose Per Week if your instructions allow different doses on different days e g Sun Wed Thu 1 1 1 1 1 1 1 2014 Anticoagulants Dosing Regimes and Instructions warfarin 283 Per Day if all instructions stipulate the same dose every day e g Sun Tue Thu 1 1 1 1 1 1 1 V Sun Mon Thu Fri Sat 1 2 1 1 1 Ve 10 1 However this rule of thumb may not be appropriate for types of Regime See the section Creating a Dosing Regime Setting the Max Step Between Instructions for full details on how to set the Max Step Instruction Settings correctly Please note if this setting is inappropriate DAWN AC may think your regime is missing dosing instructions and prevent you
306. rd 12 Company Name and Address 14 How To Use the Manual 16 A5 iesic i I A 16 Getting Started Workflow 18 Safety Section 21 Customer Obligations 32 Logging Into DAWN 35 DAWN Front Page 38 How To Navigate Around DAWN 40 Logout Confirmallori 44 Dawn LOGIN SCEE iiie cra veda Ana ERES EE UE 45 DAW MIFTONUP AGC ieee ear 46 DAWN SO AEC OPM ON eR 47 Settings for DAWN AC 49 Adding a IE ATU AUTO RNY aS AEA AEE 49 List of Health Authorilles occu ceo cec ceu se 49 Adding a New Health Authority eec M EM 50 Adding Editing Organisation 2 2 2 1141 50 IB UNSEECIMLCLCHIPINLASIIM E 52 Adding a New Organisation Ty E DE E Pose isa Soo I 53 Adding a New 58 teneis LED 53 R 55 a MS geritis M
307. re records to display Click here ta add a new 2014 Dawn Version 7 E Manual 9 9 2 Choosing a New Team Organisation Team New record Please select a Organisation For the table Team 45 Dawn Clinical Software Morrside Hospital Big Hospital 2014 Settings for DAWN 9 93 Adding a New Team Team New record Organisation Bia Hospital Name Notes InUse TeamMember 2014 Dawn Version 7 E Manual 9 9 4 List View Team Filter List view Scheduled Tests patients All risk classes All diagnoses Any karget range al All clinics any date All rales All teams 9 10 Personal Settings Filter With Scheduled Tests records Faund 09 00 yetanother test 09 00 Pye Delia 09 00 Fielding Mina 09 00 Stellar Steven 09 00 Ferguson Stacey 09 07 2009 0 00 25 06 2009 0 00 31 07 2009 0 00 05 07 2009 0 00 18 11 2009 0 00 TestDate INR Target TIR Drugs Events Pr e al 40 2 00 100555 2 50 65 2 90 100 2 80 100 Yes DAWN Personal settings are user specific and can be used to determine which tabs and screens the user will and will not view within the system 2014 Settings for DAWN AC st que uper nra Tan Grace N Tue 23 06 2009 DAWN ME RE Version 7 9 1245 Anticoagulation
308. re to support monitoring of anticoagulation with new oral anticoagulant agents non vitamin K antagonists include Non VKA list view for easy management of scheduled reviews section 5 1 e Integrated non VKA history and warfarin treatment records within the patient record section 5 2 e otructured questionnaire approach to check for contraindications interactions risks section 5 3 Help to follow the recommended prescribing guidelines section 5 4 Powerful reporting on patient outcomes and population data section 5 5 Able to provide support separately for other agents besides Dabigatran through specifically designed questionnaires for each agent section 5 6 The DAWN AC non VKA module for Dabigatran etexilate provides structured questionnaires based on the recommended use of the anticoagulant and these include questionnaires for Initiation of anticoagulation and for routine Follow up Completion of the questionnaires can be scheduled for future dates so that the user can keep track of patients started on Dabigatran or due for a change to Dabigatran anticoagulation This software should be seen as an aid to the Healthcare Professional It is a condition of use that all instructions or information issued by the application are checked by a competent healthcare professional before instructing the patient Inadequate reviewing of patient instructions and the next review date could cause severe injury or death C
309. re to type your user name and password correctly using the correct combination of capital and small letters ensuring that the Caps Lock is on and off at the correct times Take care not to confuse the letter O and the number zero or the letter and the number one mm am Username Lisa password aeeeeese If vou want to change your password please alta fill the following two fields 4 1997 2009 45 Information Systems Ltd EN If you would like to change your existing password a new password can be created from this screen Before doing this hover your cursor over the blue I icon to the right of the new password field This gives the criteria that the password must meet following two fields The length of the password must characters at minimum The password must contain at least 3 alpha 7 character s The password must contain at least 1 numeric 0 9 character s The password must contain at least 1 Special fone of e R ee character s ywing warni evere injury lead to data corruption This could lead to severe injury aTe u Although these settings can be altered within the system the default requirements are as follows The length of the password must be at least 6 characters long The password must contain at least 3 alpha characters e g A B C a b C etc password must contain at least 1 numeric character e g 1 2 3 etc
310. rent value Click this button to suppress this warning Maggie clicks the red question mark to confirm she wants to give this instruction The question mark turns to an exclamation mark showing that she has acknowledged the warning Maggie accepts the dose When Maggie doses the patient on their next maintenance test automatic dose calculation is prevented as the last dose was a Bridging Therapy This ensures that a bridging instruction is not used as a basis for the next maintenance dose 2014 Anticoagulants Dosing Regimes and Instructions warfarin ERR i 5 w s a Dosing x INR 2 6 InRange Date 16 07 2009 Y w5 scheduled Warnings Calc prevented Previous treatment was a Bridging Therapy Dose manually ERROR No doting instructions found Treatment notes Status Tested Next In the event that Maggie neglects to switch the therapy to Bridging dose calculation is also prevented if he previous dose contained a LMWH instruction e he previous dose comprised a major edit This is where the doses for two or more days differ by more than the smallest unit used in the regime If the Regime contains 1mg tablets and the smallest permitted tablet part is half a tablet the smallest unit would be 1 2 mg If the smallest tablet strength used in the Regime is 3mg and the regime only permits whole tablets the smallest unit would be 3mg 25 7 2 Scenario Handling Doses that
311. rimaryDiagnosis BEFORE the induction Target range 1 5 2 5 12 0 Target T algorithm is chosen when E Regime Warfarin 1 Mg Daily Dose Start date 01 03 2010 First creating editing the treatment plan Induction algorithm TAIT ET AL INDUCTION Sample instruction Sun Mon Tue Wed Thu Fri Sat PILLS 1 SIZE PER DAY i nun There B standard induction algorithms included within DAAN although ic 45 Dawn Clinical Soft additional custom induction Ch algorithms can be added if si EET ARRA needed Click here ta see the stop x MaxInterval list of standard algorithms ProblemPatientFlag C that we include time in range Once you have set up the treatment plan for induction dosing the patient is very much like maintenance dosing where DAWN suggests a dose and next test date based on the INR entered 2014 Managing Patients Under Different Therapies 215 EEUU EUER Dosing INR 1 1 Low Y Date 01 03 2010 Scheduled For Man 01 03 2010 09 00 13 00 in clinic Anticoag Clinic Hospital Mon Tuel Wed Thu warnings mo 5 5 4 Jj 5 5 5 5 Treatment notes no previous dose Dose 5 00 d Status Tested Next Ssiosizoio fee 4d Please Note During Induction therapy most protocols suggest testing at intervals that are less than a week If you use a formatted HTML dosing regime as above DAWN automatically custo
312. rsion 7 E Manual Other contraindications Active clinically significant bleeding Hepatic impairment or Iver disease expected to have any impact on survival Hypersensitivity to dabigatran etexilate Hypersensitivity to sunset yellow E110 Organic lesion at risk of bleeding Severe renal impairment CrClz30ml min The list of contraindications displayed on the Initiation Questionnaire may be edited added by your system administrator using the Look Up Tables called Risks and Specific Risks NB any risks identified on the Initiation Questionnaire will NOT automatically display at the top left of your patient screen You may wish to highlight these manually on the patient screen either by adding Risks for a new patient or clicking on the Risks button to add risks for an existing patient screen Riskdass High Pref dinic selected Phone home in Atrial fibrillation nonvalvular 05 09 20127 Dabigatran 150 mg twice daily 2 New back to Initiation Questionnaire page back to Risk Settings page 27 2 1 2 10 Haemorrhagic risks Please tick any of the risks which apply to your patient These risks are identified in prescribing guidelines as significant risks for consideration in dosing decisions for Dabigatran 2014 New Oral Anticoagulants non VKA Section 407 Haemorrhagic Risks Active ulcerative Gl disease Bacterialendocarditis
313. ruction in Single Strength Tablets Creating a DayPattern Instruction in Mixed Strength Tablets 8 If the Regime is weekly the Total Dose field is automatically filled in with the SUM of the individual doses for each day If the Regime is Daily the Avg Dose field is automatically filled in with the Average of the individual doses for each day 9 If you enter a dose for any day that is not divisible by so cannot be achieved in multiples of the minimum tablet part of the minimum tablet size you are prevented from saving the instruction A message box informs you which dose cannot be achieved and the minimum tablet part permitted You are returned to the form with offending dose highlighted Further checks are performed on all regime 10 The lower limit is automatically set as half way between the Avg dose or Total Dose for this instruction and the Avg dose or Total Dose for the next instruction down in the regime in other words the instruction with the nearest Avg Dose or Total Dose that is lower than the new instruction 11 Upper limit is automatically set as half way between the Avg dose or Total Dose for this instruction and Avg dose or Total Dose for the next instruction up in the regime in other words the instruction with the nearest Avg Dose or Total Dose that is higher than the new instruction 12 When a new instruction is added the upper and lower limits of any surrounding instructions are updated accordingly so tha
314. s E H MSADC Anonymous access and authentication control Hg vti bin Enable anonymous access and edit the GE WebSite authentication methods for this resource 1 8 MOM 1 56 Printers E 9 Tony WebSite 5 28 Dawn AC 7 E oe Dawn AC Te E mgl aspnet client E images E sg private E vti cnf vti lag 87 088 pwt script vti txt IP address and domain name restrictions A Grant or deny access to this resource using IP addresses ar internet domain names Secure communications secure communications and Certificat o enable client certificates when this sleet Eee etsi ss is resource accessed view Edit Cancel Apply Help 5 Deselect the Anonymous Access option and ensure the ntegrated Windows Authentication option is selected Adding a New Anticoagulation Patient 175 18 Adding a New Anticoagulation Patient There are several steps needed to add a new patient into the system We go through these in order below Mon 29 06 2009 Version 7 9 1245 Patient view Add edit or dose a patient List view Daily routines Attendance and non attendance Diary 3 gt Consult the diary Message center Manage messages and pass messages by phone Reports Custom repo rts Settings Modify your personal settings Current location for printing Select a location 2014 176 18 1
315. s a general rule of thumb choose Per Week if your instructions allow different doses on different days e g Sun Wed Thu Fri 1 1 1 1 1 1 1 2014 288 Dawn Version 7 E Manual Or Per Day if all instructions stipulate the same dose every day e g sun Mon Thu Fri Sat 1 1 1 1 1 1 1 v Sun Thu Fri Sat 1 1 Ve 1 gt 1 1 1 However this rule of thumb may not be appropriate for types of Regime See the section Creating a Dosing Regime Setting the Max Step Between Instructions for full details on how to set the Max Step Instruction Settings correctly Please note if this setting is inappropriate DAWN AC may think your regime is missing dosing instructions and prevent you from activating it See the section Activating Deactivating and Maintaining Regimes Activating a Regime Validation Checks Missing Instructions for further details 3 See the section Setting Defaults for New Instructions for advice on filling out the Defaults for New Instructions fields 4 Please note Miss and Boost Days are expressed in mg if the patient s regime is expressed in Mixed Tablets for example Take 0 00 mg for 2 days Take 7 50 mg for 1 day 25 4 2 1 4 Setting the Max Step Betw een Instructions step between instructions mug per laxInstrucktionDaoseIncrement 1 5 Defaults for new instructions DayPattern
316. s and Events Look Up Information List view settings Reports Custom modules Automatic Authorisation of INRs Questionnaire Definitions Data and operational integrity User Checklists Safety Check List for Patient Searching and Adding Editing Patient s Details When adding a new patient the user should perform a thorough search to ensure 2014 2 Dawn Version 7 E Manual the patient s details have not been previously entered Be aware of name misspellings and transposing numerical identification numbers when searching Ensure all patient data including all data entered via any of the tabs on the patient screen has been entered and checked for correctness Attention should be paid to the last name first name unit number and date of birth so that the patient can be uniquely identified every time Ensure all patient procedures that are entered into the system have been checked for correctness Ensure all patient events that are entered into the system have been checked for correctness Ensure all patient reminders that are entered into the system have been checked for correctness If you are using the maintenance module ensure the patient is stable and has reached the maintenance dose if the patient is a maintenance patient Ensure the patient has not been incorrectly marked as deceased or inactive Safety Check List for Adding Editing Patient Treatment Plan Details Ensure all treatment plan data including
317. s date to toc aY dass ooe __ Dru QS Date clinic Anticoagulation Clinic 12 345 610 374 3522 home fr Scheduled For Fri OF 08 2009 09 00 in clinic Anticoagulation Clinic Reschec Na warnings 2 0 3 0 2 5 Target Click WARFARIN 10 MGE 2034 2008 Indefinite t eatment notes 4 dose zero Dose 0 00 w z ns 1 b cfl acti K Status NEM m Warnings ir Field or click red A accept the date pone _ 19 Dawn Version 7 E Manual 20 4 1 Set Date To Today 1801 Paremill Rd LLL Mot schedule Schedule me Date gt Ma warning dose zero Dose 0 00 w Status Scheduled I8 un schedule T a TER n 20 5 Acceptthe Dosing Instruction Date 03 04 2012 a O T 3 4 4 5 4 4 4 Dose Change 2 OUT OF 3 ABOVE 3 0 Total ma 4 459 E INR CHECK WITH PATIENT Dose decreased by 14 JStat er Tested Niext 10 04 2012 Ed Sun Mon Tue Wed Thu Fri 5 4 454 Sun Mon Tue Wed Thu Fri s os cs s s m m m 2014 Dosing a Warfarin or ot
318. s displayed in compatibility mode 3 If you plan to display instructions for new Dosing Regimes created 7 7 onwards in compatibility mode you must ensure all the required text fields for each instruction are complete The first two text lines are created automatically from the days and doses entered in the daypattern but the third and fourth lines are blank by default If the text in these lines does not change between instructions you can define default values for these fields in the Regime just as if you were creating a non day pattern instruction see Setting Up Regimes and Instructions Regimes and Instructions Creating Non Daypattern Instructions Thus in the example above PILLS 3 mg SIZE PER DAY Entered as default in the Regime or manually in each instruction 4 Compatibility mode instructions cannot be defined for Regimes comprising more than one tablet strength This functionality is included for backwards compatibility only It is not necessary to define old style instructions for new regimes if you plan to display instructions in the formatted style We recommend you move to using formatted HTML instructions if you use Day Patterns 2014 Anticoagulants Dosing Regimes and Instructions warfarin 25 4 Setting Up Regimes and Instructions The following sections show how the Regime and Instruction tables are set up 25 4 1 Anticoagulants Tablet Strengths and Brands 25 4 1 1 Anticoagulants Looku
319. s page Technical note the table name for Interacting drugs is AnticoagulantlnteractionDrug 27 7 4 Specific Risks for non VKA Haemorrhagic risks thromboembolic risks and contraindicated conditions may be stored in this table for use in patient questionnaires These settings populate the questionnaire screens for haemorrhagic risks and other contraindications section 6 1 2 9 and section 6 1 2 10 Specific Risks Anticoagulant Dabigatran Risk Organic lesion at risk of bleedin Risk Type Contraindication Clinical Advice ontraindicated NB deletion of an entry for Specific Risks may cause loss of information in any patient questionnaire not completed or unlocked for editing back to Settings for New Oral Anticoagulants page Technical note the table name for Specific Risks is AnticoagulantRisk 27 7 5 Regime and Non VKA Dose Regime settings are required for each Dabigatran or other non VKA dose to be used in DAWN AC Each dosage needs to exist as a Regime a non VKA Dose and as a 2014 ao Dawn Version 7 E Manual Permitted Regime If a new dosage or dosage frequency is approved you may add this to each of the 3 following tables as appropriate so that the settings are available in a DAWN AC patient record Hegime Regime Acenocoumaral Whole Tablets in Mg Daiy Avg Daily Active B Dabigatran 110 mg twice daily Daily Active Dabigatran 150 mg twice daily Daily Acti
320. safe and accessible place for ready reference by your users Make frequent checks that this is the case Preventing and not allowing adding or editing of data in the underlying database by using a third party program or tool All data access must be done through the DAWN Clinical Framework Keeping all the application files complete and together Do not copy files from previous copies of the application into the current set of files The application files have a high inter dependency and require absolute referential integrity Encouraging use of the practice system to rehearse any infrequently used procedures before live execution Using the practice system to test out future upgrades before applying the upgrade to the live system Ensuring that users do not enter real or live data into it your practice or test system and use it operationally Ensuring that the system is checked thoroughly after any upgrades patches are installed on the live system Ensuring any old out of date user manuals or e books are destroyed and the current versions are readily available with no sections missing in full or in part Have a contingency plan in place should your computer system hardware or software fail such that you can continue to manage your patients until the computer is operational again 2014 32 Dawn Version 7 E Manual 5 Customer Obligations CUSTOMER SOFTWARE USE OBLIGATIONS 1 All dosage and test interval advice
321. se on Thu and Fri As such she double clicks the dosing instruction box to enter a custom instruction manually The Customise Dosing Instruction form is displayed Maggie types in the warfarin dose for each day 2014 Anticoagulants Dosing Regimes and Instructions warfarin 355 Sun Mon Tuel Wed Thu Fri Sat es 1 1 1 1 Enaxaparin Daltenarin Fandaparinux Status Tested Accept dose To enter the LMWH details she clicks on a drop down list of LMWH drugs Maggie selects Enoxaparin from the drug list A drop down list of different drug regimes based on different mg per kg and dose frequencies is displayed Customize dosing instruction Tue Wed Thu Mon Tue Wed Thu rT ir b Ib E BEN Maggie selects 1mg per kg q12h This is a 12 hour regime so DAWN displays two lines one for AM injection time and the other for a PM injection time The patient weights 168 165 which DAWN automatically converts to 76 2 kg His weight was measured 4 days ago so is still valid to use in a dose calculation The calculated dose is 76 2 kg but the nearest available syringe size is 80mg so DAWN rounds the dose to 80mg Customize dosing instruction Warfarin Tue Wed Thu Mon Tue Wed Thu 080 80 Ymd w 20 0080 w LMWH 1 mg per Kg 12 12h single amount Patient s weight 76 2 kg
322. see below 2 It is not possible to remove days from the beginning or the middle of the instruction The latter action makes no sense However if you are dosing a patient on Tuesday and the you want to test them again on Friday you may wish to exclude Friday and Saturday from the end of the instruction and Sunday and Monday from the beginning In this case simply change the first day of the week to Tuesday so Friday Saturday Sunday and Monday all appear at the end of the instruction then double click Friday to remove all four days 3 You can reinstate a day that has been removed from the instruction by double clicking its greyed name All removed days before the day you click are also reinstated Any removed days after the day you reinstate remain removed 2014 2 Dawn Version 7 E Manual 4 instruction spans 7 days it is assumed that the pattern repeats each week If an instruction spans less than 7 days it is assumed the patient is to be tested again on the day following the end of the instruction For example if an instruction includes doses for Mon Tue and Wed DAWN AC expects the patient to be tested again on Friday If the recommended next test date suggested by the dosing engine or set manually is later than expected for example the instruction spans 3 days and the recommended next test interval is 7 a red question mark alert is displayed next to the recommended interval You cannot accept the dose until y
323. setting e f your search finds one or more patients the search results display a checkbox beside each patient s NHS number to show whether it has been verified i e it has a status of 01 Number present and Verified e You can type an NHS number with or without the spaces as the search value and DAWN looks for any patients with a matching number with or without spaces In other words typing 0123456789 in the NHS No search field finds any patient with 012 345 6789 or 0123456789 as their NHS number automatically formatted in 3 3 4 format e g 012 345 6789 However any numbers that were already in DAWN prior to switching on compliance are only reformatted when you next edit the number or change its verification status This is why DAWN always searches for the number with and without spaces v When you switch on compliance any NHS number you subsequently enter is HINT You can use the operator in a search value to mean OR For example if you want v to search for a patient with the first name Sid but you are not sure whether he spells it Sid or Syd you can type Sid Syd in the First Name search field and DAWN will HINT for patients called Sid or called Syd When compliance is switched on and you search for an 5 number DAWN automatically updates your search value to search for the number you entered with or without spaces For example if you type 0123456789 in the NHS No field and press search DAWN changes
324. st view Daily routines MeetingTemplate attendance and non attendance Jest ReFerenceRange Tesraroup Therapy Template Trial DrugTemplate GuestionnaireType GeneralLookupCategory Team 5 Lookup tables Anticoagulation Tables Diary ye Consult the diary Message center Manage messages and pass messages by phone Reports Custom reports Settings Modify your personal settings BloodGroup Diagnosis Current location Far printing Select location Crug Category Induction Maintenance Expla Dru gInterackion EthnicOrigin Active Patients 1 Patiend e Event Missed Test 0 1 Needs HCProFessionalType next test date 2 Weeds 2014 148 Dawn Version 7 E Manual 13 Coded Comments You can define short codes for frequently used comments for example nbb for no bleeding or bruising The CodedCommentPrefix system setting is used to define a prefix by default that identifies the text you type in any notes field as a short code As such you could type nbb anywhere in a Patient Note Treatment Note or Quick Note and this would automatically expand to say no bleeding or bruising when the note is saved To define coded comments e Press F5 to display the system menu e Choose Management Coded Comments to show the coded comments list this is empty to start with Frontpage Patien
325. stAlias Therapeutic Indications Qualifying Risk Factors Interacting Drugs Specific Risks Permitted Regimes Hon VKA Dose Ouestionnaire Settings The settings here are critical to how your DAWN AC system operates and any changes deletions additions are likely to affect the anticoagulant dosing of past present or future patients ALL changes to settings should be tested thoroughly on a test database before applying changes in your production database ALL outputs like letters e mails from the DAWN AC system should be checked carefully for completeness and accuracy by a suitably qualified healthcare professional before the patient is instructed For a new oral anticoagulant 4S Information Systems Ltd will supply settings for Anticoagulant Regime Non Dose and Questionnaire Settings It is unlikely that you will need to modify these settings but please contact the support team support 24s DAWN com with any questions or issues From time to time you may need to review of consider updates to the following tables for a particular anticoagulant e Therapeutic Indications section 15 1 if Dabigatran may be used in a new condition now e Qualifying Risk Factors section 15 2 if new risk factors emerge or age limits change e Interacting Drugs section 15 3 if new information emerges on concomitant drugs affecting the chosen anticoagulant e Specific Risks section 15 4 if new conditions are found to affect Dab
326. start a new one 2014 Anticoagulants Dosing Regimes and Instructions warfarin 269 25 4 1 1 1 Creating a New Anticoagulant Record 1 Choose Lookup Tables Anticoagulation Tables Anticoagulant from the System Menu to access the Anticoagulant lookup table and press the orange New button at the foot of the form The anticoagulant form is locked to prevent inadvertent editing so the new anticogulant form is not displayed straight away Instead a message box appears informing you that you must unlock the form before you can add a new regime 2 Press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document Windows Internet Explorer wWARMNIMG You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again to accept these terms and to edit the data 3 To accept these terms press OK and then press the Edit button again as directed in the message box The An
327. sting single strength regime and adapt it to include more than one tablet strength or change it to a different single tablet strength 1 Follow the instructions in the preceding Cloning a Dosing Regime section to clone your regime To insert and additional tablet strength 2 Change the Dose Units from Tablets to Mixed Tablets 2014 Dawn Version 7 E Manual Description WARFARIN 6 MG WEEKLY DO CodeName WARE amp W Clone InUse Xl Status In Maintenance Anticoagulant warfarin Brand 5 Generic Warfarin Daily Weekly Meal DoseUnits Tablets MinimumTabletPartk Half a tablet ShowInstructionTotalDoseLine Tablet 1 amp 6 00 Pils amp mg Blue Green USA Y Regime in single tablet strength Two additional tablet strength selection lists are displayed Description WARFARIN 6 Ma WEEKLY CodeName WwAReEw Clone Status In Maintenance 550292 Anticoagulant Warfarin Brand U54 Generic Warfarin Daily Weekly DoseUnits Tablet 1 Tablet 2 Tablet 3 Mane selected Regime changed to mixed tablet strengths 3 Select the additional tablet strength or strengths you wish to include in the Regime Ensure you select the smallest at the top and the largest at the bottom this may mean moving the existing size if you wish to include a smaller tablet If you select the tablets in the wrong order the following Message Box is displayed and you are prevented from savi
328. stionnairelT ype GeneralLookupCategory Team Lookup tables Reports Management To search for a patient from anywhere within the system click on the Search button at the top left of the screen 2014 How To Navigate Around DAWN Close alltabs se d tabs system ment stem meni Patient search aien search Reports X LicenseAgreemend Click NewPatientyyvizard Tr 4 patent License_MaxActiva_ Frontpage Normal Tables Healthouthority e Organisation Ward HCProfessional Clinic i Patienttroup LoginLoq Clinic diary e Meeting MeetingTemplate e Test ReferenceR ange e Jestroup Therapy Template Trial DrugTemplate Questionnairelype GeneralLookupCategory e Team Lookup tables Reports 25 Management 2014 Dawn Version 7 E Manual 81 Logout Confirmation Screen Date af birth Search Last name First name Date of birth MRN Status stevenson Lisa 0141713922 54657565 Inactive Ferguson Stacey 05 0161 9953 23453545345 Active Pearson Paul 0100113895 213244 Active Fielding Mina 2059945 Br85574 Active Stellar Steven 017011939 457456 Active Pye Delia 14110144843 2544 Active vetanother test 017011966 464646 Active Induction Patient as Active 2014 How To Navigate Around DAWN 4 8 1 1 Dawn Login Screen If you want to change your password
329. stionnaires To schedule a questionnaire 1 Pressthe button on the Questionnaires tab az 2 Set the due date as appropriate NEE 13 Dabigatran 150 mg twice daily 3 Press OK 4 1 b ofi active Personal Treatment plans Questionnaires Test Results e Entry date f Dabigatran Initiation 30 08 2012 CrCL not recorded Dose 1 On adding an Follow up Questionnaire change the Due Date to the date you will complete the details Dabigatran follow up Patient Name Eddie Alderson Due Date Unit 078137 Click OK at the bottom of the Questionnaire screen to save this Initiation with the scheduled date You will find the questionnaire on the questionnaires tab for later completion RI Personal Treatment plans Questionnaires 2 am QuestiannatireType Entry date fu Dabicatran Follow up 05 08 2012 Scheduled 2014 Dawn Version 7 E Manual back to Complete a Follow up page back to Detailed Workflow page back to Starting a Non VKA Treatment Plan page 27 2 3 2 Complete a Follow up Non VKA The Dabigatran Follow up Questionnaire will display details from the patient s treatment plan as shown It is not possible to schedule a Follow up Questionnaire unless an active Dabigatran treatment plan has been set Patient Name Vincent Price Due Date J5 09 2012 Unit 189455 Status Scheduled Questions Therapeutic I
330. t Fou are currently fogged an ar Support 45 with user orate Too Grade DAN CLIN FRAME Patient view Add edit ar dose patie List view Daily r attendance and non atter 1 Consult the diary Message center Manage messages and pa ila Reports Custom reports Settings 2014 Settings for DAWN 55 9 31 List of Organisations Organisation Selection GwnOrganisation Show all CR Search for OrganisationType Mame Hospital Name argani EXE jLaboratory vendor Address Chatsworth Rd workington InUse Address Address Emm 45 Dawn 45 Dawn Clinical Software Software K 21 PlChatsworthRd Rid Scotforth Scotforth Lancaster 2014 Dawn Version 7 E Manual 9 3 2 New Organisation Form Addressi Address Town County PostCode usus on these additional tabs Email OrganisationCode HealthAuthority Team mL 9 4 Adding a New Organisation Ward Optional Wards can optionally be set up within the system to monitor inpatients You must have an Organisation set up within the system before creating a new Ward 2014 2014 LicenseA greemaent License MaxActivePatienticount Frontpage Normal Tables Healthauthority Or
331. t List view Message Center Reports Normal Tables Lookup tables Reports Management Clinic View settings MessageManagement Printing Reports Audit amp security System CodedComment CustomModule e Choose the New button to add a coded comment CodedComment a Search for ShortCode FullCorment O e Save your comment 2014 Coded Comments 149 e n your patient notes screen place your code e g e When you SAVE the coded comment the full comment will appear on the screen 2014 Viewing Unmatched Interface Results 151 14 Viewing Unmatched Interface Results You can view two types of unmatched INRs test results within DAWN 1 The Hold Monitor displays messages that the interface has been unable to fully process main reasons that a message may be put on hold include Invalid data in the message for example a zero INR an invalid appointment date No matching patient within DAWN More than one matching patient within DAWN patient does not have an active treatment plan If you have an Anticoagulation INR only interface also The result sample date is not in the recent past for example it is more than 14 days before today The exact number of days is configurable within DAWN Different result sent for same day for same patient Patient has a more recent result already Patient has a previous test that has not yet been auth
332. t Identifier If you make the NHS Number mandatory you will not be able to add new patients unless you can enter valid NHS Numbers for them straight away n 2014 2014 Enforcing Mandatory Use of the NHS Number 2 Read all the information on the page carefully to ensure you understand the implications of switching on NHS number compliance and that you know which level of compliance will best serve your current needs For more information on the difference between Full Compliance and Validate amp Verify Only see Key Principles in the Overview section of this Topic 3 Click on the drop down list of Enforce NHS Number Compliance options The following options are displayed Enforce NHS Number Compliance 4 Select the appropriate level of compliance from the drop down list 5 Check the mandatory patient identifier is set to the appropriate setting Mandatory Patient Identifier Unit Number Unit Number NHS Number Please note if your system is configured to display the unit number on screen witha different caption such as MRN or Hosp Number the drop down list and help text HINT display your caption We advise making the unit number i e MRN Hospital number the mandatory patient identifier rather than the NHS number because you cannot save a patient record without an entry for the mandatory patient identifer If you do not know a patient s unit number when you add them to DAWN you can put i
333. t Strength or none selected If you select the tablets in the wrong order DAWN will not permit you to save the Regime and you will have to press the Cancel button and start again The numeric tablet size for each Tablet is automatically updated with the size of the tablet you select If you have selected a brand the list of tablets in each drop down list includes only tablets for this brand If you have not selected a brand tablets marked as In Use for all brands are displayed It is advisable to mark tablets for brands that you do not use as Not In Use so they are not available for selection While no instructions exist for the Regime you can change each tablet strength for a different strength tablet However you must ensure Tablet 1 remains the smallest strength and Tablet 3 if used remains the largest You can also deselect the largest tablet strength to reduce the number of the tablet strengths from three to two or from two to one Once Instructions exist for the regime you can no longer deselect tablet strengths and you can only swap the existing tablets for tablets of the same strength from other brands There is one exception to this rule where only a single tablet strength is selected you can change this for a tablet of a different strength and the upper and lower limits and average daily or total weekly doses for all instructions are automatically recalculated 4 Choose the minimum tablet part that is permissible in
334. t s anticoagulation 2014 New Oral Anticoagulants non VKA Section ast Treatment plans AC Anticoagulation 07 09 2012 Target range Anticoagulant Rivaroxaban 10mg Once Daily Referring GP Consultant 03 04 2012 Treatment stopped Stopped at 07 09 2012 11 50 Dabigatran 110 mg twice daily Patient decision back to Changing Anticoagulant page 27 3 3 Changing between and non VKA 27 3 4 2014 In DAWN AC stop the treatment plan and start a new treatment plan for a change in the patient s anticoagulant Treatment plans for Stephenson Hedley 01 07 1932 Disease area PrimaryDiagnosis Start date Duration in weeks Status Wr Anticoagulation ATRIAL FIBRILLATION 11 04 2008 10 03 2008 stopped Disease area Anti ine ACTherapy C Induction PrimaryDiagnosis ATRIAL FIBRILLATION 11 04 v Maintenance Start date first seen date C Manual Bridging Duration type Long Term ER 7 2 0 3 0 2 5 Target Treatm ent sf ped A First STOP any existing Warfarin 2 mg Strength Preferred clinic Teleri i Telephone treatment plan m None selected Preferred time From Sun Mon Tue Wed Thu Fri CessationReason zira aar ERI 1 151 151 181 Elevated str Pils 2 5 mg Status stopped MaxPercentDoseChange Note DAWN AC will prevent a change of anticoagulant within an active treatment plan back to Changin
335. t the Upper Limit of one instruction is equal to the Lower Limit of the next instruction up 13 If the gap between the Avg dose or Total Dose for the new instruction and the next instruction up and or down in the regime exceeds the Max Step Between Instructions limit 2014 Anticoagulants Dosing Regimes and Instructions warfarin 295 for the regime the upper and lower limits are set to half the MaxlnstructionDoselncrement setting above and below the Avg Dose or Total Dose accordingly and the surrounding instructions that exceed the permitted increment retain their original upper and lower limits This usually indicates you have missed out an instruction See the section Creating a Dosing Regime Setting the Max Step Between Instructions for details 14 When you attempt to activate a Regime DAWN AC performs checks to ensure all instructions in the regime are valid complete and contain no duplicates DAWN AC does not allow you to activate a regime if any of the following discrepancies are found e One or more Instructions have the Same Avg or Total Dose e he Regime contains Missing Instructions e gap between the Highest and Lowest Day for any one instruction is too big e Selected Tablets do not match the Selected Brand 15 Press the New button again to add another instruction 25 4 2 2 1 Creating a Day Pattern Instruction in Mg 1 DayPattern checkbox defaults to the value of the DayPattern checkbox for the
336. t view Daily routines attendance and non attendance Diary Consult tha diary Message center Manage messages and pass messages by ia Reports Custom reports Settings 2014 Settings for DAWN AC 1 9 15 1 List of Diagnoses Search for Description CodeName G larjcaroioversion anticoagulation clinical Haematology Rheumatology None selected m Anticoagulation clinical Haematology Rheumatology None selected bd Anticoagulation clinical Haematology 5 ANEURSYM WITHEMBOLICER E Rheumatology None selected Anticoagulation clinical Haematology Rheumatology Mone selected i Anticoagulation clinical Haematology Rheumatology 5 ANTI PHOSPHOLIPID syNDRd SS selected Anticoagulation clinical Haematology Rheumatology 5 ANTITHROMBIN 111 DEFIE SS iNone selected Anticoagulation clinical Haematology Rheumatology x Mone selected hd Anticoagulation 5 AORTIC ROOT REPLACEM clinical Haematology Rheumatology Down Mey eem Pont 2014 104 Dawn Version 7 E Manual 9 15 2 Adding a New Diagnosis Diagnosis New record Description CodeName InUse DiagnosisGroup Diagnosisstage DiagnosisApplication rea_Diagnosis_pkiDiagnosis Len cave oe 9 16 Adding Editing
337. tarting after a period on different or no anticoagulation please stop the treatment plan and start a new treatment plan 1 click on Treatment plan on the Patient screen 2 select a Cessation reason mandatory only if cessation reasons are available on your DAWN AC database this option may not be set up for your DAWN AC system 3 click on stop 4 click on OK to the pop up box Uist view Patient Treatmentplans x Treatment plans for Black Carmella 01 01 1942 Disease area Pomaryiapnoss Anticoagulation ORTHO KNEE Total knee replacement surgery 06 09 2012 0 Disease area Anticoaauiation PrimaryDiagnosts ORTHO KNEE Total knee Start date 06 09 2012 First date Duration type Short Term Duration Weeks Days 12 wks Due to stop 29 11 2012 Preferred clinic Nane selected Preferred time From EE until CessationReason Patient decision Status active Are you sure you want to perform the action stop on record Anticoagulation 06 03 2012 You can give a short explanation in the text field below optional int add relevant details in the Notes tab as they will be easily viewed later on the Treatment Plans tab of the main patient screen like this 2014 New Oral Anticoagulants non VKA Section 415 Disease area Anticoagulation PrimaryDiagnosis ORTHO KNEE Total knee Start date 06 09 2012 First seen Dura
338. ted ChanzeDate Time FieldName From alue 2009 15 30 d amp uthorisedDateTime 02 07 2008 15 30 10 0210212009 15 30 fki amp utharisedHCprafessionallD Big Hospital Support 42 02 07 2009 15 30 StateTransition AuthoriseDose O2f07 2008 15 30 StateTransition AcceptDose O20 72009 15 30 ncustomizatianL evel 0 2 0210212009 15 30 ibaysInlnstruction B O2f07 008 15 30 moustominstructions Tablet1 4 4 4 4 4 4 Initialbase 2009 15 30 nDail eeklv 2 1 nh nd P new oa ve 3 Choose OK to close the message box and edit the instruction to reflect the dose the patient has actually been taking When you return to patient view the Treatment record displays the adjusted average daily or total weekly dose A blue exclamation mark highlights the fact that the dose has been amended to show the actual dose the patient took rather than the dose they were instructed to take 2014 Anticoagulants Dosing Regimes and Instructions warfarin 255 Dose rime linrange Comments Wed 23 09 2009 0 00 da Y Wed 02 09 2009 29 3k Y Wied 26 06 2009 23 3 00 j aisi E dose the patient took Warfarin Sun Mon Tue Wed Thu Fri Sat Y Wied 19082009 2 1 3 00 d ifi m 1l a 20 2 Sp S 3 1g 2 Wed 12 05 2009 28 3 00 cf Dose the patient was supposed to take Y Wed 22 7 2008 34 3 00 d ifl Warfarin Sun Mon Tue Wed Thu Fri Sat mg _ Y YU TUUS S 3 00 dg _ 3 3 3 3 3
339. tep between adjacent dosing instructions is allowed to be If all instructions increment in steps that do not exceed the Max Step settings DAWN AC sets the lower limit of each new instruction to the same value as the upper limit of its preceding instruction and ensures this value is the half way point between the average or total dose of the two instructions However where this would result in a step that is larger than the Max Step setting DAWN works out what the lower and upper limits should really be taking the Max Step setting into account and uses these instead This ensures a patient is never given a Dosing Instruction that is too big or too small because it just happened to be the nearest to the intended dose However if the Max Step settings are inappropriate DAWN may impose gaps between instructions that would not exist if the Max Step settings were set correctly The Max Step settings default to the Minimum Tablet part of the smallest tablet strength in a Regime You must then choose whether each instruction steps up by this amount per week or per day As a simple rule choose Per Week for Minimal Increments regimes Or Per Day for Same Dose Daily Regimes If you are upgrading from an older version of DAWN AC this setting defaults to Per week as the majority of dosing regimes use the Minimal Increments pattern For example if your regime contains 1 mg strength tablets and you allow tablets to be broken in half the Max Step se
340. tered and imported custom modules have been thoroughly tested before using them in a live situation Safety Check List for Automatic Authorisation of INRs If you have purchased and are using the automatic authorisation module Ensure thorough testing has been carried out on your practice system before switching on automatic authorisation in your live system Perform routine checks to ensure that only the correct INR s are being automatically authorised Safety Check List for Questionnaire Definitions If you have purchased and are using the questionnaire module Ensure all new altered and imported questionnaire definitions have been set up and 2014 Safety Section checked for correctness For each questionnaire definition Ensure the questionnaire definition has been correctly defined with the correct name and code and has been assigned to the correct department Ensure all the options calculations have been defined correctly Ensure all new altered and imported questionnaire definition have been thoroughly tested in your practice system before using them in a live situation Safety Check List for Data and Operational Integrity Ensure you have written procedures and physical arrangements for Checking all user profiles are properly set and are checked to be working Checking that the system settings are appropriate to the environment and method of working and to optimise system performance within your organisati
341. tern instructions For example you may have a plain text instruction which says Take no warfarin for a dose of zero in a regime which otherwise comprises of day pattern instructions The following section Working with Dosing Instructions describes how dosing instructions are displayed and edited in Patient View and Message Templates The section Setting Up Hegimes and Instructions describes how dosing regimes and instructions are added and configured Working with Dosing Instructions The following sections show how to use and customise dosing instructions 2014 Anticoagulants Dosing Regimes and Instructions warfarin 229 25 3 1 Day Pattern Instructions formatted Brand Anticoagulant Display Mame Image definable by brand FERI and tablet strength 9 WR 2 6 InRangi Caption indicates tablet ES strength doses in Warfarin Sun Mon Wed Thu m tablets not mg Fi 2 gU dide erii on instruction bo customise Date 22 07 2009 Y Mot scheduled Ma warnings Optional Calculated 7 i Treatment notes Total mg line M No dose change Dose ne ee Next 12082009 ae cycles all lines in E synch Background of dose p change info rather History 7 than instruction ee shaded redjblue to V MR amp
342. the list of scheduled patients 27 5 Handling Non Attendance for non VKA Patients If a patient fails to attend for a review of their Dabigatran therapy update the scheduled Follow up questionnaire with a new date for their appointment J lt E Dabigatran Follow Up 02 07 2012 Overdue Dabigatran Initiation 18 06 2012 CrCL not recorded Dose 110 mg twice daily Print any letters faxes e mails as required from the Letters tab Letters You may be unable to create some letters and messages until the ne Select a Direct Print Local printer Dabigatran DHA for Followup 31 05 2012 14 07 If a patient persistently fails to attend or have their blood tested you may wish to contact their 2014 asa Dawn Version 7 E Manual GP or even discharge them from your monitoring service You may wish to stop the treatment plan and mark the patient as Inactive on the Personal tab 27 5 1 Non attendance process explains how to e Find patients overdue for review e Record any necessary action Generate letter or e mail to the non attending patient see the following sections for more information Using the list view to find patients who are overdue for follow up Changing the treatment plan 27 6 Running Reports i 7 Fri 31 08 2012 DAW N 9 Version 7 9 25 1284 E Anticoagulation Patient view Add ed
343. them by Size 6 You can change the tablet picture displayed in formatted dosing instruction for regimes expressed in Tablets by clicking the paper clip icon to display a File Open dialog and selecting an alternative image 7 You can change the Caption displayed in a formatted instruction for a tablet by typing in the caption field You can also define alternative text that could be displayed in a report in place of the image 8 If the Tablet has not yet been used in any Dosing Regime you can change the Tablet Size or Strength by typing the correct number in the TabletSize field Once a Tablet has been used in a Dosing Regime you can no longer edit the Size 9 To change the brand of a tablet sort by Size The brand is displayed as a drop down list box for each tablet size Select the correct brand from the list 2014 Anticoagulants Dosing Regimes and Instructions warfarin AnticoagulantTablet Warfarin Sorting ByRegion BySize BY searen or conten 0 5 M M Mg m amp 1 a Taro TT Warfarin Coumadin USA Coumadin Jantoven USA Jantoven Barr USA Warfarin UK Generic Warfarin St Marevan Ms Pils img pon c c 3 USA Generic Warfarin Please note for non vitamin antagonists like Dabigatran Rivaroxaban etc please see section on New Oral Antic
344. ticoagulant form is now unlocked 4 Press the New button The new anticoagulant form is displayed 2014 270 Dawn Version 7 E Manual Anticoagulant New record Description Motes oo Tablets au will need bo save this new record before you can add related records Order 4 Enter the name of the Anticoagulant in the Description field If you try to save the record without typing a name in the Description field a message box informs you that the Description is required and you are returned to the form with the Description field highlighted 5 Enter the DoseUnits e g mg the Anticoagulant is normally prescribed in This field is not required as it is not used directly in dosing instructions Tablet Strengths Dosing Regimes and Dosing Instruction records combine to create the actual dosing instruction for a patient As such you can save an Anticoagulant record without entering the DoseUnits 6 Enter any notes about the Anticoagulant in the Notes field The notes are not required and you can save an anticoagulant record without entering any notes 7 Enter an Order number for the new Anticoagulant This field is required so you cannot save the record without entering it It controls where in the list the new Anticoagulant appears The item with the lowest order number appears at the top of the list The item with the highest order number appears at the bottom of the list The order defines the ord
345. ticoagulation department and run there instead If you intend to fax messages DAWNMailer must reside on a computer that has a modem attached to a phone line You must also install Microsoft Fax Microsoft Fax is part of Windows XP and can be set up by choosing the Set Up Faxing option in Windows XP s Printers and Faxes control panel choose Start Printers and Faxes To set up DAW NMailer 1 Create DAWNMailer folder on the PC where you intend to run DAW NMailer 2 Copy the DAWNMailer exe and HTML Printer exe if present files from the Polar Studio Webroot folder to your new DAW NMailer folder Double Click DAW NMailer to open the application DAW NMailer attempts to start automatically At this point you may receive an error message as DAW NMailer is not correctly configured yet 4 Click OK to close the error message DAWNMailer dialog is displayed in Stopped mode Fill in the fields as follows 2014 Setting up Printing User Guide 163 16 3 16 4 2014 Enter the http address For Dawn AC http JDawnsServerDawnac where Dawnserver is the name of Your server do nat include the ipdex hkml ar polarserver asp page name IF vou wart to send emails enter the address of yow SMTP server Open your Print Stetian in Dawn AC highlight the Identification Key and press Ctrl C En copy ib Click into this Field and press Ctrl V to paste in the key This configures th
346. tient is 1mg choose 1 If you only use a single tablet strength of say 3mg choose 3 mg This setting is used to validate that all doses defined in instructions and instructions customised for patients can be achieved with the tablets available Please note the Minimum TabletPart field see below also has some bearing on this The numeric tablet size is automatically updated with the size of the tablet you select 5 While the regime contains no instructions you can change the tablet selection to another tablet of any size Once instructions have been designed for the regime you can only change the selected tablet to another tablet of the same size 6 Choose the minimum tablet part that is permissible in an instruction This defaults to Half a Tablet but can be changed to Whole Tablet or Quarter of a Tablet When defining instructions for a regime or customising a dosing instruction for a patient 282 Dawn Version 7 E Manual DAWN AC prevents you entering a dose that cannot be achieved in multiples of the smallest tablet part of the smallest tablet size Regime 0 Y TEM TT Dg d OF PTD WARFARIN 5 Weekly WARFARIN 6 MG WEEKLY DOSE Weekly WARFARIN 7 5 MG WEEKLY DOSE Weekly Yartarin Induction in hig Daily Avg Daily WARFARIN MIXED TABLETS WEEKLY Weekly Yartarin Plain Text Regime Daily Be Wartrin nieve regime Daily Description CodeName Inuse X Status New Activate Anticoagulant Warfarin B
347. tion type Short Term 12 wks Due to stop 29 11 2012 Preferred clinic Mone selected Preferred time From until CessationReason Patient decision Status a increasing GI upset switching to warfarin for remaining 4 weeks GP informed AC Anticoagulation 25 10 20127 Target range 2 0 3 0 2 5 Target Anticoagulant Warfarin img Strength in Tablets Daily Avg Consultant Start date 06 09 2012 7 Duration Treatment stopped Stopped at 25 10 2012 Target range Anticoagulant Dabigatran mg once daily Referring GP Consultant Notes easing GI upset switching to warfarin for remaining 4 weeks GP informed Cessation Reason Patient decision back to Detailed Workflow page 27 2 3 Follow up Questionnaire To review the dose for a patient on Dabigatran or other non VKA agent locate the patient record using either the search facility or the list view 2014 ate Dawn Version 7 E Manual List view Daily routines Attendance and non attendance Work List Mon Attendance Clinic Summary Status Annual Review Reminders fe Questionnaire Status summary Black Bertha 32423452354 None Scheduled None Scheduled Clarke Cherise T the None Scheduled DavidLasti DavidFirsti 123789 record None Scheduled Horrible Horace 32423434 2 Mone Scheduled Bloogs Joe Troubl
348. tions as detailed in this manual Please keep this manual in a safe place for ready referral by your staff What Safety Issues Are There The DAWN Clinical Framework web application provides the functionality to manage your anticoagulation patients The application allows for INR results to be imported via an interface or entered manually and to calculate the next dose and next test date If you are to import results via an interface please also read the Interface Safety Manual The application should be seen as an aid to the Healthcare Professional It is a condition of use that all instructions or information issued by the application are checked by a competent healthcare professional before instructing the patient Inadequate checking of the Dose and Next Test Date could cause severe injury or death Check that each dose and next test date instruction are correct clear and safe for each patient WARNING Use the software in accordance with the design intent as specified in the User Manual e g use the Maintenance module for stable patients and the Induction module for initiating patients Segregrate and manage patients by risk level e g unstable patients and patients in transition stopping starting changing protocols interacting medication changes and previous thromboembolic or bleed events Use the appropriate treatment management protocol and appropriate competent personnel for each patient s indication and risk status Ch
349. tment The main reasons that a test result may be 2014 152 Dawn Version 7 E Manual put on the Test Result monitor include The patient has a Closed Unlock visit Asoftware problem has occurred License_MaxActivePatient ount Fou are currently fogged on ar Support 35 whl usar prae Too Grace Frontpage i gt Normal Tables tables Reports Management Clinic View settings MessageManagement ETT Printin Re EE Patient view c3 s amp security Add edit or dose a patient DawnInterface List view Daily routines Attendance and nan attendance Hold Monitor Inbound Interface Configuratic InboundMessageParameter OutboundInterFace Test Result Monitor 5 System CodedComment Diary Consult the diary Message center Manage messages and pass messages bw phone ia Reports 4 Custom reports Pu Settings Modify your personal settings Current location For printing Select a location Category induction Maintenance No of Active Patients Patients Missed Test 1 Needs re next test date 2 Weeds sc 2014 Viewing Unmatched Interface Results 14 1 Hold Monitor Screen Sorting Oldest first Newest first ByUnitNo Last Name ByMessageType By Hold RR Search for Disease area P HoldReason astName UnitNo Delete all 5 records Delete marked records
350. to accept these terms and to edit the data 4 To accept these terms press OK and then press the Edit button again as directed in the message box The Regime form is now unlocked 5 Press the New button The new dosing regime form is displayed Description ew Status Anticoagula B Brand None selected Daily Weekl DoseUnits Instruction au will need to save this new record before you can ad 2 step between instructions mg per MadaxInstructionDoseIncrement Defaults for new instructions DayPattern 222 2 Inpart instr LH Pd npr instr LH DE 22 2 Inpart instr LH IEEE 2 y y Inpartinstr Clone Regime 6 Type a description and codename for the regime Then select the anticoagulant from the drop down list 7 f the numeric doses you record in DAWN are average daily doses so if a patient takes 7mg per day you record a dose of 7 select Daily from the DailyWeekly dose If you record total weekly doses so if a patient takes 7mg per day you record a dose of 35 select the Weekly option 8 If you wish to associate the Regime with a particular brand of the anticoagulant select the 2014 Anticoagulants Dosing Regimes and Instructions warfarin Brand from the drop down list If you choose a brand the brand display name rather than the anticoagulant display name is shown on any formatted instructions The br
351. to display the system menu and choose Management Printing Print Station If you are on DAWN AC version 7 0 choose Normal Tables Print Station to display the Print Station screen e Choose the orange New button to add a new Print Station e Enter a name e g General Hospital PrintStation Name Seneral Hospital Remote IP address es Locked Identificationkey 1641D66F8273C9D8 Create random key EA Motes Retuntmaiiaddress Supported organisations here are no items to display Printers here no items to display 2014 162 Dawn Version 7 E Manual 16 2 e Click on Create Random key to generate a unique identification key for this print station and then Save e Press the new item button to add the organisations that will use this print station to the oupported Organisations list e Leave the Printers list blank This is automatically populated by DAW NMailer The PrintStation handles all Event Messages triggered by users belonging to any of its supported organisations However if no DAWN Mailer is running the messages remain queued inside the print station You need to set up the DAW NMailer to send out the messages Setting Up DawnMailer to process Messages for a Print Station DAW NMailer is installed the Polar Studio W ebroot folder on the DAWN AC server It can be run on the server itself or it can be copied to another machine perhaps a dedicated PC in the an
352. tor edits the settings for Anticoagulation Tables back to Initiation Questionnaire page 27 2 1 2 12 CHADS and HASBLED scores CHA DS VASc and HASBLED scores may be optionally recorded form the dropdown menus on your questionnaire CHA DS VASC score HASBLED score None selected None selected Mone selected 0 Risk was 0 9 in one study 1 Risk was 3 4 in one study 2 Risk was 4 1 in one study 3 Risk was 5 8 in one study 4 Risk was 8 9 in one study 5 Risk was 9 1 in one study 6 Risk not known too litte data 7 Risk not known too litte data 8 Risk not known too litte data 9 Risk not known too litte data The dropdown options are provided from the settings in your DAWN AC Normal Tables General Lookup Category CHA2DS2 VASc Score and HASBLED You may wish to request that your system manager updates the options available 2014 New Oral Anticoagulants non VKA Section 40 back to Initiation Questionnaire page 27 2 2 Non VKA treatment plan Non vitamin K antagonist therapy is recorded on DAWN AC using a new treatment plan Modules are available for Dabigatran Rivaroxaban and other anticoagulants allowing protocols for initiation and follow up of each type of therapy Stephenson Hedley 01 07 1953 H67 eee ee G CR CN RA Pref Non Prince Regent Infirm w Phone 101912 678 3678 home Age 53 non VKA 28 06 2012
353. truction that is a customisation that changes the pattern of doses and days but does not affect the overall total weekly or average daily dose the numeric dose and up down last dose and cycle buttons remain enabled 10 A customised instruction is carried forward as the dose instruction for successive tests so long as neither the dose or regime changes This is the case even if the total weekly or average daily dose does not match a standard instruction in the instruction table The LMWH part of the see add a LMWH Instruction instruction is never carried forward 11 Clicking the Cancel All Customisations button resets the instruction back to the default instruction suggested by the dosing engine When you click the Cancel All Customisations button you are prompted to confirm you wish to cancel all customisations 12 When you set up a regime you specify the smallest unit by which a dose can increment This is either the smallest tablet size half the smallest tablet size or quarter of the smallest tablet size depending on whether half or quarter tablets are permitted If the doses for any two days in the instruction differ by more than the smallest unit a red question mark alert is displayed against the total or average numeric dose field If you click on the question mark to acknowledge that you wish to keep this pattern as you might if you were specifying bridging instruction that includes days with no warfarin and days with loading doses
354. truction comprises one line of checkboxes 5 Check the boxes for the days on which you want the patient to take the injection When you press enter or Save or close the Customise Instruction form a syringe icon is displayed against each of the days you selected for this LMWH dose and time 6 The dose time defaults to 08 00 08 00 am Modify the time where appropriate by over typing the existing value with the required time 7 f the patient is due for a procedure on say Wednesday you may wish them to take 24 hour dose on most days but only take a 12 hour dose on Tuesday so they are not anticoagulated by the time of their operation In other words specify one injection time but different amounts on different days In this case choose 24h two amounts from the drop down list to display a second dose line Specify an alternative dose and select the days on which each dose should be taken 8 Dosing Contacts Letters Drugs Events Procedures Reviews Reminders Groups Documents Owners Account Audit INR 1 7 Low Y Date 19 11 2007 Y Customize dosing instruction Sat Mon Tue Wed Thu Sat Sun Tue Wed E Sat 5 Mon Tue a Sun Mon Tue Wed Thu Dose 1 9344 Y LMWH Tinzeparin w 24h two amounts A 9 The second dose defaults to half the amount of the first dose 10 you wish the patient to have take the dose every 12 hours Select 12h single amount from the dr
355. tructions The Dosing EnableCustomizeaWeekPatterns System Setting determines whether anyone is permitted to customise individual dosing instructions for patients To change this setting 1 Press F5 to display the system menu 2 Choose the Management System SystemSetting option to display the system system settings form 3 Type Dosing EnableCustom in the Name field in the orange Search Panel at the top and press the Search button Dosing EnableCustomizeaWeekPatterns system System oetting is displayed SystemSetting Sorting By Type Name Last changed Customizations nane aaa a een LLC LLL D asing EnableCustamizedWweekPatterns Does the system allow dosing week paterns to be customized Integer 0 _ _ _ _ _ _ AX J ANE O O 4 Change the Value to 1 Permit users to customise dosing instructions depending on User Profile settings see below 0 Prohibit anyone from customising dosing instructions Changing the System Setting to 1 enables you to give certain groups of users permission to customise instructions By default no users have this permission so you need to edit the appropriate User Profiles and switch this permission on To switch this permission on for a User Profile 1 Press F5 to display the system menu and choose the Management Audit amp Security UserProfile option to display the UserProfile form 2 Select the appropriate User Profile from the list display at the
356. ts AllowAdvancedPatientTabSheets AllowDeletePatient 4 Press Save to save your change 4 Dawn Version 7 E Manual C AllowEditPatientTelAppFields L Contacts Letters Events Iv Procedures v Reviews Groups Documents Graph v History Iv NextOfKin v Clinical v Owners v Audit v TreatmentPlans Questionnaires PatientResults InboundMessages 2014 4 Dawn Version 7 E Manual 29 29 1 Variance Growth Rate VGR This chapter describes the Variance Growth Rate VGR functionality added to DAWN AC in version 7 9 33 of the application including An overview of the reasons why the functionality has been added to DAWN AC the fields which have been added are calculated and what they show Where the VGR fields display Enabling the VGR functionality Use of VGR values in letters VGR setup Click HERE to read more What is Variance Growth Rate VGR Overview It is known that Percentage Time in Therapeutic Range is not a very good indicator of the likelinood of a patient having a bleeding or thrombotic event However a new research study has found that in certain circumstances the Percentage Time in Range can be used to indicate an increased risk of a thrombotic event and that in other circumstances a calculation of the variability of the patient INR Variance Growth Rate or VGR can indicate an increased
357. ts Dosing Regimes and Instructions warfarin 349 multi dose vials either ensure the possible range of doses is included or delete all syringe Sizes so you can type in doses rather than select them from a predefined list 5 Check any LMW HDrugRegimes listed are appropriate Deselect the InUse checkbox for any that are not See Setting Up LMWH and Pentasaccharide Agents for full details To amend the display name for any AC Brands for example to have Coumadin tablets display as warfarin on instructions 1 Choose Look Up Tables ACBrand to display the ACBrand list ACbrand a Search for Name 5 0 NN Wafan Coumadin Usa Dantoven USA parus Wafan E USA Generic llWwafain 2 Amend the display names as appropriate 25 6 4 Selecting Tablet Strengths and Activating your Regimes During the upgrade process DAWN AC automatically creates formatted HTML versions of your existing Day Pattern dosing instructions It also maintains the original plain text versions which are displayed by default see Switching off Compatibility Mode However the upgraded regimes need you to complete certain new fields before they can be used Consequently the upgraded Regimes are not activated by default If you try to dose a patient on a regime that has not been activated DAWN AC is unable to display a dosing i
358. ttings would default to 7 gt mg per week This default should always work for Minimal Increments regimes where all instruction step up uniformly However it may be too small for e Same Dose Daily Regimes e Regimes where instructions for larger doses increment in larger steps to instructions for smaller doses In a same dose daily regime the dose for each day is the same for example Thu Average Lower Upper HH NN m 075 425 2014 sis Dawn Version 7 E Manual As such the step between instructions is gt mg per Day as opposed to mg per Week If the Max Step settings are set to gt mg per week DAWN AC thinks the step between each dosing instruction is 7 times bigger than it should be and assumes there are missing instructions As such it caps the size of the upper and lower limits for each instruction as follows resulting in gaps RR m ET Dose Limit Limit Bop t t h t ho 096 104 _ me a mme m m as r o 2 e gt 2 e 200 _ aa 2 m 26 2 2 2 25 26 _ 1 _ Solution Amend the Max Step Between Instructions so they are correct for the Regime in this example to 7 mg per Day DAWN AC automatically recalculates all the upper and lower limits As none of them now exceed the Max Step setting the lower limit of each is set to the same value as the upper limit of its preceding instruction and all gaps disappear If y
359. ual MessageTemplate uis record 1 50 107 PrinterPaperType Part Site Specific Style Settings Frenchay Doze Letter cPart Full next test day and date estes ne First 2 lines of current dose cPart dase change flag Part HTML Style Sheet compact Name ParE Site Specific Style Settings w o PrintablePatientMessage MailMergeType um Em 9 Template HTML M PrinterPaperType None selected oo Mone selected DIY margin left 15mm pagetable Jwidkh 1863 height z37mm margi Plain Paper JeftEable width 81 mrm righttable Jwidkh 101mm address padding left 8mm height 74mm verbia etica sans serif font size 12pt hasna height 7mm vertical align center Font F ont size 12pt hhsna height Smm vertical align center Font F onk size 10pk Jastname height Smm vertical align ceenter Fa Firstname heighk Smm vertical align center fo dob height 11mm vertical align top Font Famil hisbtaryceamment height 4mm vertical align cen ans serifi font size Spt LitlehieighE height 10mm vertical align center eriF Fanb size Spt Date width 10mm font family arial helvetic INR width 8mm font family arial helvetica 4 16 7 Selecting Paper Type in Message Event This will supersede the settings applied fo
360. und colour of the box itself As such in 7 7 the background of the Dose change or No Dose Change message displayed beneath the instruction is coloured to denote the size and direction of the dose change instead 25 3 2 Customising Dosing Instructions 1 Hovering over any part of the instruction in the dosing panel displays a tool tip saying Click here to edit 2 If the User has permission to edit instructions see User Profile settings double clicking any part of the instruction displays the edit screen 2014 Anticoagulants Dosing Regimes and Instructions warfarin 231 d Y Y 4 Y Cancel all customisations INR 2 6 InRange Date 22 07 2009 Y v ENS EU Mon Tue wed Thu Close editing Form Sun Mon Tue Wed Thu Fri Sat Tis LMWH drug dase change Dose 50 00 w Status Tested Next 3 wk Pwr Dose Time linrange comments Y Wed 22072009 2 6 50 00 1 3 wk Y Wed 08 07 2009 21 5000 wig 2wk EX Wed 0177 2009 26 5000 7d Missedtabletsforlasttwo days Y Fri 25 05 2018 24 5000 wap EA B wk H Fri 15 05 2009 2 6 20 00 w di B wk 4 D Tue 14 04 2009 2 6 21 00 w di Wied 08 04 2009 21 21 00 w di 07 04 2009 2 7 21 00 ve ib Mon 04 2009 21 21 00 vw el 3 Change the dose for any day tablet strength by typing a new value in the appropriate field and press
361. unit number and the NHS number for example 2014 Enforcing Mandatory Use of the NHS Number 455 HH5 Humber Status STEPHENSON Hedley 01 07 1942 H6 72563 012 3456789 01 28 7 Restricting Who Can Change NHS the Number Status By default all users who have permissions to add and edit patient records can change the NHS number status for a patient However you can remove this specific permission from certain user profiles if you so wish To restrict who can change the NHS number status 1 From the DAWN System Menu choose Management Audit and Security User Profile to open the User Profile screen 2 Select the profile you wish to change from the list of existing profiles at the top 3 Uncheck the checkbox for AllowEditNHSNoVerificationStatus under the Patient section 2014 Meeting MeetingTemplate Test TestAlias ReferenceRange TestGroup TherapyTemplate Trial QuestionnaireType GeneralLookupCategory Team 4 Lookup tables Reports 5 Management E5 Clinic View settings MessageManagement MessageTemplate MessageEvent MailMerge Printing Reports Parameter Report Polar Reporting Audit amp security Workflow loq Logged changes R eadLog DatabaseConversionLog Update database DawnInterface System n AllowCreatePatient AllowEditPatientData ABD NOR UM AllowViewPatientTelAppFields AllowedPatientTabShee
362. upper limit of one instruction is more than the lower limit of the next one up Applying the check described in point 1 above covers this too 2014 328 Dawn Version 7 E Manual 25 5 NEV Vyarfarin 1 amp Sma Tablets Mvesekly with Halves vyeekly In Maintenance F Undetined Weekly E WARFARIN 1 MG WEEKLY DOSE weekly Active WARFARIN 1 MG WEEKLY DOSE Clone Weekly In Maintenance Be WARFARIN 10 MG WEEKLY DOSE Weekly Active Warfarin 1 Strength Cin ea Daily Avo Daily Mew Wartarin 1ma vole Tablets in Ma Daily Avg Daily Mew VA 2 S DOSE Weekly Active k Description WARFARIN 10 MG WEEKLY DOSE CodeName WARIOW InUse X Status Active Anticoagulant Warfarin Brand 54 Generic warfarin DailyWeekly Weekly DoseUnits Tablets MinimumTabletPart Half a tablet ShowInstructionTotalDoseLine Tablet 1 Pills 10 mg White USA Generic 1 Instruction record 1 50 70 2 LowerLimit UpperbLimit Total dz 25 125 275 325 375 425 step between instructions 5 mg per Week MaxInstructionDoseIncrement 2 Defaults for new instructions DayPattern E Line 1default In part instr Line default In part instr Line3default In part instr l poema e ei ILE 3 Dose a test patient using your new regime Use the up and down arrow dose increase decrease buttons to step through each of the instructions in turn when the dose change exceeds the max al
363. ure Risk Message center Severity Manage messages and pass messages by Severity Type RiskClass Reports Application rea PP Custom repo rts Diagnosisaroup DiagnosisStage Settings 2014 Dawn Version 7 E Manual 9 14 1 List of Blood Groups TT CNN S 773 postive 2014 Settings for DAWN AC 101 9 14 2 Adding Blood Group BloodGroup New record Description E blood group InUse Re a en MWS Oe L Pic zi 9 15 Adding Editing Diagnoses If you need to add a diagnosis that does not exist in the standard list new diagnoses can be added here 2014 102 Dawn Version 7 E Manual LicenseAgreement License Max ActivePatientlount Frontpage Normal Tables Lookup tables Anticoagulation Tables e Allergy GloodGroup amp Diagnosis Crug Oruginteraction EthnicOrigin Event HCProfessionalType JournalltemType LetterTemplate Organisation ype Procedure e Risk Severity Severity Type RiskClass Spplicationarea DiagnosisGroup DiagnosisStage mc Welcome Fou are commend fogged on ar Sunport 45 ahh prone Tap Grade antico Patient view add edit dose a patient Lis
364. ured within the DAWN system These need to be tested thoroughly if edited or added The support team at DAWN can configure message templates for you if these are needed Please test any new amended message templates carefully before using with real patient data 2014 Dawn Version 7 E Manual LicenseAgreement Welcome License _MaxActivePatientCount Frontpage Normal Tables Lookup tables Reports Management Clinic View settings MessageTemplate MessageEvent MailMerge Printing amp Reports Parameter amp Polar Reporting Audit amp security E3DawnInterface System CodedComment Fou are currently bogged an Support 359 seh wrer proie Top Grade DANN Anticaaqulati Patient view add edit ar dose patient List view Daily routines attendance and non attendance Diary Consult the diary Message center Manage messages and pass messages by phone Reports Custom reports Settings Modify your personal settings 2014 Settings for DAWN AC 127 9 23 1 List of Message Templates MessageTemplate record 1 50 105 22 aL LINE a gt Part Site Specific Style Settings oO Frenchay Dose Letter cPart Full next test day and date cPart First 2 lines of current dase cPart dose change flag Part HTML Style Sheet compact Name J Part Site Specific Style Setti
365. us DoseSet 7 Authorise 2014 Dosing a Warfarin or other Vitamin K antagonist Patient 20 12 Authorise Messages Treatment notes The Following message s will be sent Dose Label gt Patient Dosing Instruction gt Smith Lucy Email Mon 06 04 2009 21 21 00 ve di 2014 Producing Messages Manually From DAWN 2 21 Producing Messages Manually From DAWN Letters emails and faxes can be sent directly from the DAWN system To set messages up to be sent automatically from the system please go to the Setting Up Printing User Guide section of the manual To manually produce a letter email or fax from DAWN AC click on the Letters tab on the main patient screen ew to Scheduled For Tue 28 03 2011 11 00 12 00 to the Letters tab in clinic default Reschedule manually gt Ma warnings Treatment notes H dose zero Dose 0 00 d Status Scheduled esceptan ma pumesen R aaa 21712708 Tue 29 03 2011 0 0 O 00d 21 1 Letters tab New Road Kendal e a a i CallAssure anintme 2014 204 Dawn Version 7 E Manual 21 2 Letters Tab Dose Not Authorised Message ew ial TOR You may be unable to create som
366. utputs including letters emails links to other systems etc Records of the results of the validation shall be maintained The validation should be authorised by the lead clinician physician A separate Test System which simulates live operation is highly recommended 8 It is vitally important that the customer site establishes a robust method of backing up and restoring their data including occasional tests of the backups through restoration at an appropriate interval Usually this is at the end of each working day If there is a lot of system activity a more frequent back up procedure should 2014 Customer Obligations 33 possibly be considered 9 The customer is expected to operate best practice with regard to keeping their copy of the software up to date The product is being periodically updated with important safety and operational features If you are paying software maintenance fees these upgrades are usually free 10 The customer is expected to keep abreast of key changes and urgent issues in the product and documentation by visiting the webpage http www 4s DAWN com DAW NSafety Notices htm weekly 11 The customer should notify 4S immediately if they notice any anomalies within the data or experience anything within the system that could potentially cause a mishap 2014 Logging Into DAWN 35 6 Logging Into DAWN When opening up DAWN you will need to log in with your user account Take ca
367. ve Dabigatran 150mg once daily Daily Active Dabigatran 220mg once daily Daily Active Dabigatran 75mg once daily Daily Active Description Dabigatran 110 mg twice daily CodeName DAB110TO Status Active Anticoagulant Dabigatran Brand None selected DailyWeekly Daily DoseUnits Mg MinimumTabletPart Half a tablet Tablet 1 None selected Instruction ere are no items to display The settings are similar to VKA doses in this table except that no Instructions are required NB deletion of an entry for Regime may result in multiple patients not getting a dose or next appointment Non VKA Dose The settings for non VKA regimes link to a numeric Total Daily Dose which is stored in this table for reference Elements of the settings for a chosen regime are compared between the regime chosen in a treatment plan and in the Questionnaires and this is the basis of some of the validation checks on each patient Non VKA Dose Total Dally Dose Dabigatran 110 ma twice daily 110 mg Twice Daily 220 Dabigatran 150mg once daily 150 mg Once Daily 150 Each regime for which a dose check is required needs to have a setting in this table lf a Dabigatran Initiation Questionnaire requires this dose check it will not be possible to activate a treatment plan for the new dosage without a setting in this table 2014 New Oral Anticoagulants non VKA Section 27 7 6 2014 The settings here are criti
368. vou Treatment notes Dose decreased by 10 Dose 45 00 Status Tested Next ns jazr2one ES 7 d Accept dose NN RN ime Comme Wed 01 07 2009 45 00 w ifl Fri 26062009 24 50 00 ve ifl B wk 15 05 2009 25 20 00 wif B wk TE Tue 14 04 2009 26 21 00 w ifl Wed 08 04 2009 24 21 00 w ifl Tue 07 04 2014 27 21 00 w ifl l Mon 05 04 2008 21 21 00 2014 198 Dawn Version 7 E Manual 20 9 3 Zero Dose 1801 Paremill Rd Bransty Reading Editing record M gt Tiny m n re rum Dosing INR 3 7 High Y Date 01 07 2009 Not mE o oo Tablets For 1 days then h Status qe Next lnajozr2znao E 7 Accept dose 20 9 4 Set No Dose Change Dosing INR 2 6 InRange Date 01 07 2009 v w Mot Tablets For days then Sun Mon Tue Wed Thu Fri Sat SERRA Non H 5 10 my T dose change j eo dose change Dose 50 00 w 1 frr 2014 20 9 5 Dosing Tablets for Sun Mon Tue M No dose change Status Tested Accept dose PRS Fri 15 05 2009 Tue 14 04 2009 Wed 08 04 2009 Tue 07 04 2008 Mon 06 04 2008 20 10 Treatment Notes 2014 Stevenson Lisa Anticoagulation Clinic 12345
369. w button to add a new dosing instruction The instruction form is locked to prevent inadvertent editing so the new instruction form is not displayed straight away Instead a message box appears informing you that you must unlock the form before you can add a new instruction 4 Press the Edit button to unlock the form A message box is displayed warning of the dangers of making inappropriate changes to this table advising to read the Safety Section 294 Dawn Version 7 E Manual of the User Manual and reminding you that by using the software you are bound by the terms of the Software License agreement and Customer Obligations document Windows Internet Explorer wWARNIMG You are about to alter data in tables that are used by Ehe Dosing engine Inadequate settings in these tables can lead to severe injury and death Read the Safety Section in the User Manual By using this software the user is bound by Ehe terms of the Software Licence and Maintenance agreement and Customer Obligations document Press the edit button again to accept these terms and to edit the data 5 To accept these terms press OK and then press the Edit button again as directed in the message box The Instruction form is now unlocked 6 Press the New button The new instruction form is displayed 7 Enter the doses as described in the following sections and press Save or Enter Creating a DayPattern Instruction in mg Creating a DayPattern Inst
370. w size and press Save or close the form If the size has already been defined a message box informs you that this value must be unique You are returned to the form and must specify a unique size before you can save the record 25 5 2 Defining Different Dosing and Administration Regimes If the drug can be administered in different doses or frequencies for different clinical purposes a single set of Dose Min Dose and Max Dose fields are insufficient In this case you can set up different LMW HDrugRegimes for the drug For example for Lovenox Clexane e 1 5 mg per kg once a day 2014 a34 Dawn Version 7 E Manual e mg per kg q12h e img per kg once a day e 30 mg once a day e 30 mg qi2h e 40 mg once a day You can set up automatic regimes which automatically populate the dose and frequency 24 hour 12 hour etc fields based on the settings you provide Customize ES instruction a X Sun wj Mon Tue Result of selecting an automatic regime for a patient You can also set up manual regimes where the user sets the dose and frequency options manually for each patient but where the dose they set must fall within the Min and Max dose settings you specify for the manual regime 2014 Anticoagulants Dosing Regimes and Instructions warfarin 335 Customize dosing instruction Sun T Sun Mon Tue mm lw lw E E O M Result of selecting a manual regime for a patient 201
371. wer limits and average daily or total weekly doses for all instructions in the regime are automatically recalculated to reflect the new tablet strength 2014 284 Dawn Version 7 E Manual 5 Choose the minimum tablet part that is permissible in an instruction This defaults to Half a Tablet but can be changed to Whole Tablet or Quarter of a Tablet When defining instructions for a regime or customising a dosing instruction for a patient DAWN AC prevents you entering a dose that cannot be achieved in multiples of the smallest tablet part of the smallest tablet size O Y Y LL WARFARIN 5 MG WEEKLY DOSE Weekly Active 5 WARFARIN 6 Wits WEEKLY DOSE Weekly Active WARFARIN 7 5 MG WEEKLY DOSE Weekly Yartarin Induction Daily Ava Daily Active WARFARIN MIXED TABLETS WEEKLY Weekly Active Yartarin Plain Text Regime Daily Active Ly Wartrin new regime Daily Mew Description CodeName InUse X Status New Anticoagulant Warfarin LUISA Tablet 1 Pills 1 mg Pink USA Daily Weekly howInstructionTotalDoseLine Instruction DoseUnits Tablets MinimumTabletPart Half a tablet here are items to display MaxinstructionDoseIncrement 1 5 Defaults for new instructions DayPattern cin Pd part instr Pod part i
372. when you Enforce Compliance 4 Changes to the New Patient Wizard when you Enforce Compliance 5 Changes to the Patient Search Screen 6 Patient Identifiers in Screen Titles 7 Restricting Who Can Change NHS the Number Status Overview In the UK the National Health Service NHS has issued two Data Set Change Notices DSCN 32 2008 amp 31 2003 mandating use of the NHS number and setting out rules for how it should be stored displayed and reported in electronic medical record systems Earlier versions of DAWN already complied with many of the points for example you have always been able to store the NHS number search for a patient using the NHS number singly or in combination with other patient identifiers report on the NHS number etc However from version 7 9 27 onwards DAWN allows you to fully comply with the directive Not all DAWN customers belong to the NHS so enforcing compliance with the directives is optional By default compliance is not enforced and the rest of this manual describes a standard DAWN system where compliance is not in force This chapter describes how to switch on compliance and explains the effects of doing so Key Principles There are four key principles that apply when you enforce mandatory use of the NHS Number Validatio When you enter an NHS number it must be checked to ensure it is valid Valid n numbers are 10 characters long and only contain digits The tenth digit is a check digit which is used to
373. xceptional doses essentially miss or boost doses for certain days Maggie s instruction contains a 72 mg booster dose aimed at getting the patient s INR back up into range before reverting to his normal 5 mg per day Consequently the average of 5 83 mg is artificially high and not a sound basis for a subsequent dose calculation To prevent an inappropriate dose like this one being used as the basis for a subsequent dose calculation DAWN AC only calculates maintenance doses if the previous instruction spans 7 days INR 2 5 InRange Date 20 07 2009 Y w5 scheduled ERROR No dosing instructions found Warnings Last 3 IMR s are all falling Calc prevented Previous Instruction did not span days Dose manually Treatment notes Dose Status Tested Next El Furthermore as we have seen in the last scenario DAWN also prevents dose calculation if the previous instruction contained a major edit A major edit is where the doses for two or more days differ by more than the smallest unit used in the Regime In this case the smallest tablet strength used in the Regime is 1 mg and the smallest permitted part of a tablet is half a tablet The smallest unit is therefore gt mg The doses for Friday and Sat differ by more than 1 2 mg so automatic calculation of the patient s next dose would be prevented for this reason too 25 7 3 Scenario Maintenance Dosing
374. xtStyleDosinglInstructions is set to 1 on If the AC Display TextStyleDosinglInstructions setting is 1 on the AC DisplayDosinglnstructionsInDecimals system setting is not visible HINT If the Display TextStyleDosinglInstructions system setting is set to 0 off dosing instructions are displayed in DAWN as html formatted tables However the system also creates a plain text versions of the html instructions for use in letters plain text emails or outbound interface messages where html is not supported So long as the AC Display TextStyleDosinglInstructions system setting is set to 0 off the AC DisplayDosinglnstructionsInDecimals setting applies to both html and plain text versions of the instruction Sun Mon Tue Wed Thu Fri Sat 1 19 15 1s 1s 1s 1s PILLS 3mg SIZE PER DAY An example of an old style plain text instruction the system settings AC DisplayDosinglnstructionsInDecimals and AC DisplayDosinglnstructions Show TotalMglnDecimals do NOT apply to this type of instruction Warfarin Sun Mon Tue Wed Thu Fri Sat Pills 3 18 1s 1 1 15 15 Total mq 4 deo dio deo 4 dio dM A plain text version of an HTML instruction which includes a Total Mg line the system settings AC DisplayDosinglnstructionsInDecimals and AC DisplayDosinglnstructions Show TotalMglnDecimals do apply to this type of instruction If your dosing instructions are expressed in tablets and show a Total Mg line at the bottom you can conf
375. y then you will need to manually dose the patient until they move to maintenance as there will be no induction algorithm rules left for DAWN AC to use Standard Induction Algorithms Included in DAWN 1 Et Al Low Dose Sex Dose by Day in Both 5 mg per day INR Between Last Dose Dose Miss Days Interval Day 1 0 0 1 3 0 00 5 00 0 1 2014 2014 0 0 1 5 2 0 2 5 0 0 1 5 2 0 2 5 0 0 1 4 2 0 3 0 3 5 0 0 1 4 1 8 2 5 3 1 3 6 01 3 RA A c c c c nm rn 1 4 1 9 2 4 5 0 1 4 1 9 2 4 5 0 1 3 1 9 2 9 3 4 5 0 1 3 1 7 2 4 3 0 3 5 5 0 2 Ageno Et Al Normal Sex Dose by Day Both 7 Day 1 0 0 1 3 2 0 0 1 8 2 1 9 2 4 2 2 5 5 0 3 0 0 1 3 3 1 4 1 9 3 2 0 2 4 3 2 5 5 0 Managing Patients Under Different Therapies 217 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 1 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 in mg per day Last Dose 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 5 00 2 9 1 00 0 00 5 00 2 50 1 00 0 00 7 3 5 00 2 50 1 00 0 00 10 00 7 50 5 00 2 50 1 00 0 00 Dose 5 00 5 00 2 50 0 00 7 50 5 00 2 5 0 00 O O O O O O 0 0 0 Miss Days O O O Il Interval 28 Dawn Version 7 E Manual 4 0 0 1
376. zero Dose 0 00 w Status Scheduled Next Accept INR DNA Un schedule Dose OWA linrange comments NN Wed 22 07 2009 00 000wf Wed 08 07 2009 21 500096 2 wk Wed 01 07 2004 26 500090 79 Missed tablets for last two days 00002 Fri 25 06 2008 24 soowg 6 wk Fri 15 05 2204 26 200096 6 wk Tue 14 04 2009 26 21009 Wed 08 04 2009 21 21009 Tue 07 04 2009 27 21009 Mon 06 04 2009 21 21 00 wi 2014 22 1 2014 Test Date Changes for a Warfarin or other Vitamin K antagonist Patient 207 Select a New Date and Time from the Diray Recommended date Wed 22 07 20 Mote th PEK Class through the diary Recommended interval 14 days E t Emm De Anticoagulation Clinic ARRHYTHMIA SUPRAVENTRICULAR Anticoagulation Clinic 2345 V Fri 24 07 2009 Sat 25 07 2009 100 10 100 10 100 10 100 107 11 15 15 17 34 219 ied 19 _ 1d 7 2d 14 3d 21 Handling Non Attendance for Warfarin or other Vitamin antagonist Patient 23 2014 Handling Non Attendance for a Warfarin or other Vitamin K antagonist Patient There are two ways of rescheduling patients within DAWN 1 Mark the patient as a DNA in their main patient screen OR 2 Bulk reschedule a batch of patients within a list view PyeDelia 11 01 1943 2344 Risk class 25 i Scheduled for Thu 25 06 2009 09 00 17 00 Pref clinic Anticoagulation Clinic 12345

DAWN AC Version 7 User and Safety Manual

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