How do I review DOAC dosing?

Keeping DOAC dosing up-to-date doesn't need to be labour-intensive. Here's how...

1) Calculating Creatinine Clearance

This can be automated so that its done whenever anyone is in the records, provided it's set up for your practice and the patient has a weight recorded in the last 12m. If it's not already enabled for you, let us know if you'd like it and if there are any criteria when you would use the Adjusted Weight calculation, instead of the Actual Weight.

Patients who need CrCl calculating can be found in the clinical report: Welby Innovate Prescribing / 1 Pharmacists to Action / DOAC: Calculate CrCl following latest UE (can be automated)

If we have a recent UE but no weight in the last 12m, patients can be sent a weight questionnaire from this clinical report: Welby Innovate Prescribing / 2 Admin to Action / 1c) SEND - Comms Annex Preset "Weight Questionnaire for Medication"

If we can't send them a questionnaire, they'll be in this clinical report:

Welby Innovate Prescribing / 2 Admin to Action / 3) Weight needed for DOAC dosing but unable to send Questionnaire

2) Identifying patients who need changes

For patients on a DOAC for AF, our system can work out if their dose is correct or needs changing. Clinical reports in the folder Welby Innovate Prescribing / 1 Pharmacists to Action, will identify those who definitely need a dose change:

3) Actioning changes

The recommendation is shown on our Prescribing Overview (template / view) and on the patient home screen:

Actioning the alert will bring up the recommendation, relevant information and options:

If you haven't yet stopped the previous DOAC, you'll see a reminder to stop that.

4) Other DOACs to review

If a patient is on a DOAC for another indication, they'll appear in the clinical report: Welby Innovate Prescribing / 1 Pharmacists to Action / DOAC: Review: Not reviewed since recent CrCl & unsure whether dose is correct

Patients will only be removed from this report when has been coded with DOAC dose change or unchanged, or Anticoagulation medication review.

If a patient in this report has a medication review coded, a prompt will ask whether the DOAC has also been reviewed.

In many cases, AF is the indication, and coding that diagnosis will take patients out of the report to review manually. We are working on case finding reports to support this.