Changing dosing instructions

Please do not cancel and re-order prescriptions for Warfarin if you need to change the dosing instructions. If warfarin dosage instructions need to be changed this must be done by modifying the existing prescription – see the Modifying an Existing Warfarin Prescription section below

Prescribing Warfarin

1. In the patient record, click the Add button next to the Medication List menu item from the menu on the left.

2. Enter “warfarin” in the search box and click on Warfarin.

3. Select the order sentence. If there is no order sentence matching your criteria, select any option and edit the information in the following step.

4. Yellow fields must be completed to be able to sign the prescription. The indications and INR range can be edited at this stage. The following fields must also be completed:

• Dosing instructions – this is a freetext field.
  • Preferred format = date followed by dose, the date of next INR and if INR requested.
    • e.g. 26/9/22: 3mg, 27/9/22: 2mg, 28/9/22: INR (To be ordered)
  • Following format only to be used for stable patients:
    • e.g. 3mg daily. Next INR 28/9/22 (Ordered)

The comments section should NOT be used for prescribing a dose. Best practice is to leave this section blank and put information on the pre-admission regimen in the clerking note.

• Review date – should be set to 8am on the date you would like the INR to next be checked. This should create a pop-up alert on the chosen day. Clinicians are advised to check an INR has been ordered and create a personal reminder to check the INR and dose accordingly later in the day.

Note the review date does NOT stop the prescription being active once surpassed. The review date should be updated each time the dosing instructions are changed.

Note the requested start time is set to 6pm. If a patient has already had their dose today, ensure the start date is delayed. In exceptional circumstances there may be reason to change the time warfarin is administered from the 6pm default. First click the Requested Start Date/Time box. Adjust the time to the desired time. This then allows you to click on the Record administration: Daily section. Click the 3 dots.

5. Click on Orders for Signature, review details and then click on Sign. Refresh the screen. The drug is now prescribed.

Modifying an Existing Warfarin Prescription

1. Select Medication List, right click the Warfarin order and select Modify. Do NOT choose Cancel/Reorder.

2. Update the Dosing instructions and Review date fields.

3. Click on Orders for signature review details, click Sign and then Refresh. The drug is now prescribed.

4. To view modification history, hover over warfarin in either medication list or the drug chart, right click and select order information. The details of all changes will be listed.

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Updated: 17 December 2024