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 / 4 DOACs / 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 / 4 DOACs / Weight: SEND Comms Annex Preset "Weight Questionnaire for Medication (Med-WQ)"

If we can't send them a questionnaire, they'll be in this clinical report Welby Innovate Prescribing / 4 DOACs / Weight: 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 below, which are in the folder Welby Innovate Prescribing / 4 DOACs, will help identify what is needed.

3) Actioning changes

The recommendation is shown on our Prescribing Overview (template / view) and on the patient home screen, for example ...

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, the clinical reports below, in the folder Welby Innovate Prescribing / 4 DOACs, will help identify what is needed.

Patients will only be removed from these reports when coded with a DOAC dose change, DOAC dose unchanged, or Anticoagulation medication review.

If a patient in these reports 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 reports to review manually. We are working on case finding reports to support this.

5) Other alerts to review

Other important reports are included in the folder Welby Innovate Prescribing / 4 DOACs , including the high priority report in bold below.

DOAC: Initiate in light of latest CHADs-VASc

DOAC: Review Frailty Coding: 4 monthly monitoring only due to frailty code (updating/refreshing frailty code will remove from report for 3m)

DOAC: Review Type: Consider Switch from Edoxaban - CrCl >=95 or Weight >=120kg

H STOP Medication: On DOAC & CrCl <15