Document Dosage Changes for Patients Taking Coumadin Medication

You can document dosage changes for patients taking Coumadin medication from the Coumadin-Card template.

1. Open NextGen® Enterprise EHR.
2. On the Intake tab, select Cardiology as Specialty and select any Visit Type.
3. From the navigation bar, click Coumadin.
   The Coumadin-Card template opens.
4. To select a date and enroll the patient in the Protime clinic, click the Therapy Started field.
   1. To stop the anticoagulation therapy (Coumadin), enter the date in the Therapy Discontinued field.
   The values for the Home, Work, Ext, Cell, Lab Phone, and Lab Fax fields display from the Patient Demographics template. You can open this template from the Top toolbar by selecting the Templates icon. In the Select Template window click the Demographics tab and selectPatient Demographics.
5. Click the Lab Location field and select an option from the list.
   The details for Lab Location, Lab Phone, and Lab Fax numbers display from the Card Setup Appt Locations practice template. The practice template enables you to create and store a list of appointment locations commonly used by the practice, including office, hospital, testing, and lab. If you click the Lab Location field in the Coumadin-Card template, a list displays the lab locations that have been configured in the practice template. The Lab Phone and Lab Fax fields fill automatically, after selecting the Lab Location field based on the setup in the practice template.
6. Click the Diagnosis 1 field to enter a diagnosis code for the patient.
   If required, you can enter another diagnosis code in the Diagnosis 2 field.
7. Enter the Target Range and Lab Date details.
8. Click the INR and Protime fields and enter the desired values.
   You can enter any one or both the values.
   With these values, the labs run these tests and determine the blood clotting time, measured in seconds, and then calculate the INR. Labs generally report both the results when a Protime (PT, prothrombin) test is run.

   • INR value is numeric with two decimal places to the right of the decimal point.
   • Protime is the blood clotting time, and the result is a numeric value representing time in seconds.
9. Select the Cardioversion Planned checkbox, if required.
10. Enter the dosing schedule in the Additional Dosage field.
    

    1. Select an option in the Tablet Size field on the top row of the dosing grid.
       The tablet’s dose appears in the field.
    2. Select a tablet size.
    3. Select an option from the list for the number of tablets of this dose by clicking on a day field in the Additional Dosage grid.
       Note: If the patient is taking multiple tablet doses each day, you can change the option to the other tablet size, and document if those tablets are taken as well.
    4. Select the number of tablets to be taken from the list or select HOLD to hold the tablet intake.
    Note: You can select another size tablet or continue to use the currently selected size tablet and enter an additional dose using these fields. The Dosage field on the right side of the template automatically displays the dosing
11. To create a crystal report, click History Report.
    You can create the report only if you want to print data from the template. The crystal report includes all the information that is in the grid.
12. To add comments in the grid, click Add Comments Only.
    You must use this grid if you want to add only comments. If there is a new lab result or a change in the dose, you must enter details in all the fields.
13. Select RN Sign.
    Note: The RN Sign field has been enabled for a user in the RN Security group for Cardiology. This is done in the System Setup Preferences system template. It is a quick one-time setup by using the Create groups button.

    For more information, go to NextGen Healthcare Success Community, and download the Template Defaults Setup System Template for NextGen® Adaptive Content Engine.