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Welcome to the February edition of the
DAWN AC
Anticoagulation Software E-Newsletter for 2010.
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The
DAWN Maintenance Module - Safety Issue |
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 It
has come to our attention
recently that some DAWN users
may not be using DAWN AC in
the best or most appropriate
way when recording INR and
dose values.
When a patient is entered into
the DAWN system they are most often logged as a
maintenance patient - that is, the patient has been through
an induction process with warfarin and reached a stable
dose. The DAWN system then suggests doses and next
test intervals based on the maintenance algorithm.
If a patient is for example admitted to hospital for a
procedure, some users suspend the patient and others
record the in-patient INRs taken in the notes fields. We
have found that some users enter the INRs and doses as
history, becoming part of the patient's treatment history
records.
The problem with doing this is that the DAWN system sees these
records as normal maintenance calculations rather than a
re-introduction back to warfarin, and so may suggest a dose
based on these historical values which could be inappropriate.
There are a couple of options for dealing with these type of
INR records - as they are not maintenance doses, you could
create a new treatment plan for the patient, or you could
change the patient over to bridging therapy (available from
version 7.6 onwards) which means that the patient needs to be
manually dosed until you move them back to maintenance therapy
again.
We are also looking at ways to improve the messages and
warnings within future upgrades of DAWN AC to make this
process easier and safer for the user.
If you have any queries at all, then please reply to this
email.
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The Importance of Upgrading |
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Since launching DAWN AC version 7 several years ago, we
have been continuously working on upgrades which contain both
improvements and safety related changes to make using DAWN AC
as easy and as safe as possible. This is an ongoing process,
as we strive to improve the system's quality, safety and
productivity.
Because of this, we would advise users to keep upgrading DAWN
AC systems regularly so that you can benefit from all the new
features and improvements that the latest versions have to
offer. We cannot make these improvements in all earlier
versions of DAWN 6 and 7 as this would impact on the speed of
improving the system, and so we are continuing to create small
upgrade versions for version 7 users.
Several DAWN version 7 changes are currently in the pipeline
for release in the next few months, including:
- An easier upgrade process to make any future upgrades
quicker and more straight forward
- The option to have the historical dose instructions
displayed on the patient's History tab
- Complete NHS number compliance according to the National
Patient Safety Guidelines
These changes and improvements will mean that all version 7 -
and indeed version 6 - users will benefit from upgrading to
the latest version of DAWN AC.
With both large and small upgrades, we recommend setting up a
temporary test environment to try out the changes before
upgrading live Dawn AC systems. We can assist you with this
process and provide you with temporary DAWN certificates to
get the test system up and running.
If you have any questions regarding the latest version of DAWN
AC, or are a version 6 user interested in moving to version 7
and would like a quote for an upgrade, then please reply to
this email.
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Logging Out of DAWN AC Correctly |
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Some users have reported that they sometimes accidentally exit
out of DAWN AC by clicking on the cross icon at the very top
right of the internet browser page, rather than the cross icon
to the top of a DAWN page (see below):
When a user exits DAWN AC by closing the internet screen
rather than using
the chequered flag icon, it takes 5 minutes before DAWN AC
realises that this user
is no longer logged in and can release the user license. If
the maximum number of
concurrent users is logged in when this happens, then this can
mean that a user is
unable to log into DAWN AC for a short time.
In current versions, if you find that you have closed the
internet browser screen
accidentally, you can click on the Go or refresh button on the
DAWN clinical framework
screen that appears when you first open DAWN (before the log
in screen appears):
This will bring the DAWN screen back up for you on the same
page as before you
closed it. In our latest versions of DAWN AC (version 7.9
upwards), we have moved
the option for closing a screen in DAWN AC over to the left
hand side of the page, so
that the two cross symbols are not as close together and so
hopefully preventing
any confusion:
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DAWN AC UK
User Group 2010 |
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We are planning on holding the DAWN AC UK User
Group on the 4th and 5th of October this year at the Old
England Hotel in Windermere.
We are now looking at getting the user group talks organised
in order to provide an informative and worthwhile meeting!
If you are interested in giving a talk at the user group this
year, or have any ideas about the kind of talks / topics that
you would like to see at the meeting, then please reply to
this email.
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North
American User Group 2010 |
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The North American User Group this year is going to be held on
the 22nd of October at
 the
UCLA Medical Center in Los Angeles.
We are in need of speakers to contribute to the success of the
day. If anyone would be interested in giving a short
presentation, then we would be keen to hear from you.
If you would like to attend the user group or give a
presentation, please contact us at
sales@4s-dawn.com.
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DAWN DVT
Risk Assessment and Diagnosis Modules Available! |
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By popular request, we have developed additional DAWN modules
for DVT risk assessment and diagnosis. In the diagnosis module
you can log standard observations (blood pressure, pulse, sats
etc) together with DVT risk factors (e.g. smoker, recent
immobilisation, previous history) and assessment
questionnaires to determine the patient’s Well’s score and
suitability (where necessary) for anticoagulation therapy.
The risk assessment module is similar but focuses on risk
assessment rather than diagnosis. Both modules are designed to
lead you through established protocols, in the form of visual
flowcharts, taking you down different paths depending on the
results of the initial assessment. In the diagnosis module
different paths may lead to discharge or to further testing
(e.g. D-Dimer, ultrasound, FBC, LFT, U&E) and possible
referral to the anticoagulation clinic. Both modules include
checklists (e.g. TED stockings, LMWH given, patient taught to
self-inject) and utilise DAWN’s in-built messaging system
to inform GP’s and interested parties.
Likewise the DAWN report writer can provide audit and
statistics reports. For example
• How many patients with a Well’s score of 3 or more had a DVT
confirmed by Ultrasound?
• How many smokers vs. non-smokers were referred for
anticoagulation therapy following surgery?
Please contact us if you would like a demonstration of either
module.
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Alerts to
Prevent VTE in Hospital and after Discharge
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DAWN Clinical Framework
can provide you with a system of alerting so that VTE in
hospitals and after discharge are reduced.
A randomised trial
published in the New England Journal of Medicine
(2005;352:969) indicated that an electronic alert reduced the
risk of symptomatic DVT or PE at 90 days by 41% (p=0.001).
There was no increase in the rate of major or minor bleeding
at 30 days in the intervention group.
If are interested in more
information, please reply to this email.
Other General News....
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Herbal
Remedy Interactions With Heart Drugs |
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Researchers from the Mayo Clinic in Arizona have warned in the
Journal of the American
 College
of Cardiology recently that patients should tell their doctors
if they are taking herbal supplements, as some can interact
with heart medications.
St. John's Wort, often used to treat sleeping problems and
depression, can reduce the effect of heart rhythm drugs, and
ginkgo biloba, used by some to boost the immune system, can
increase the risk of bleeding in patients who are taking
anticoagulants. Garlic can also have a similar effect in large
quantities.
Professor of Medicine and Consultant Haematologist at Mayo
Clinic, Dr Arshad Jahangir, commented, "Many people have a
false sense of security about these herbal products because
they are seen as 'natural'.
"But 'natural' doesn't always mean they are safe. Every
compound we consume has some effect on the body, which is, in
essence, why people are taking these products to begin with.
"We can see the effect of some of these herb-drug
interactions—some of which can be life-threatening—on tests
for blood clotting, liver enzymes and, with some medications,
on electrocardiogram."
To read more of this article, please follow the link below:
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Inflammatory
Bowel Disease Associated with Raised DVT Risk |
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A study published in the Lancet recently has revealed that
non-hospitalized patients suffering from inflammatory bowel
disease are more likely to develop DVT than people without
this condition.
The study looked at data from patients between 1987 to 2001,
and it was found that while patients with IBD were 3.4 times
more likely to develop DVT, this risk was even higher in
patients suffering from an active IBD flare-up.
It was concluded that patients suffering from IBD may benefit
from receiving preventative blood clotting treatments.
To read more of this article, please follow the link below:
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Implantable
Heart Monitor Can Detect Atrial Fibrillation |
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 A
study published online in Circulation: Arrhythmia and
Electrophysiology recently has found that an implantable heart
monitor is highly accurate in detecting atrial fibrillation.
The study looked at 247 patients who had the heart monitor
implanted under the skin. It was found that the device
detected atrial fibrillation with 96.1% accuracy.
The study's lead author, Dr. Gerhard Hindricks, commented,
"The device has a limited data storage capacity (49.5
minutes of data), and this may be a limitation during longer
follow-up periods - especially since the presence of false
positive episodes may exceed the storage capacity in some
patients."
"Thus, long-term performance and validation studies are
needed to find the optimal way of handling the device."
To read more of this article, please follow the link below:
We are pleased to announce that we now have several
additional applications available to aid healthcare
professionals.
DAWN Diabetes is an advanced web-browser-based system
designed to help you establish a more efficient, effective
and safer way of managing diabetic patients. This
application can detect and flag up out of line results, as
well as aiding the management and treatment of patients by
using a diary facility and making the tracking and following
up of patients more efficient. This new application is
integrated as an additional module from version 7.6 of Dawn
onwards.
To find out more about this application, please visit our
website
http://www.4s-dawn.com/Diabetes
DAWN Haematology is an advanced web-browser-based system
designed to help you establish a more efficient, effective
and safer way of managing patients on therapies such as
hydroxycarbamide, iron (iv), erythropoietin and venesection.
The system can improve your Myeloproliferative Disease,
Anaemia or Haemochromatosis clinics by enabling you to
handle more patients quickly and safely.
To find out more about this application, visit our website
http://www.4s-dawn.com/MPD
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