Topics in this Dawn AC E-Newsletter

Importance of Large INR Change Warning
Importance of Double Checks
Dawn AC Version 6.09
Dawn AC Version 7
Forthcoming Meetings

Importance of Large INR Change Warning

At the recent User Group Dr Anne Louise Swain from Sullivan Nicolaides, Brisbane Australia noted that a common feature of patients with INR’s higher than 8.5 had a change of more than one INR unit in the previous visit.

Dawn AC does provide a warning if the current INR has changed by a set amount from the last INR measure. This current set to a change of 1.5 but this can be altered in the system keys. By using this warning you could possibly avoid patients being over anticoagulated.

Importance of Double Checks

Users of Dawn AC often deal with more than 1500-2000 patients and work in environments where high levels of pressure are common. It is possible that human errors may occur leading to the specification of an incorrect patient dose or test interval.

A few years ago we did a study with the help of Risk Management consultants and they estimated the risk to an individual patient. They concluded that with manual dose interpretation or setting, the likelihood of an error, based on 12 visits per year, is 1 every 7 patient years. With the use of computer aided dose interpretation this moves to 1 error every 10 patient years, and if you print the instruction directly into a book or letter this moves to 1 error every 20 patient years.

If you add a double check of the dose instruction before issuing the instruction to the patient and print directly into a letter or book, the likelihood of an error moves to 1 every 13700 years – more than 600 times safer than having no double checking process at all.

The full Risk Management report is available on our website (http://www.4s-dawn.com/dawnac) under Latest news

Dawn AC Version 6.09

This is now available as a development release, but only to users who have already upgraded to version 6.08. Version 6.10 is currently in development and should be available within two months and will include a full release and further changes.

Anyone not already on 6.08 will need to wait until version 6.10 is available. Here are the improvements in 6.09:

Improvements have been made to the way logins are recorded and released. This should reduce problems with resetting users and ‘4S locks’. In the event of a user suffering an abnormal exit from the system, for whatever reason, they should restart their machine before attempting to log in.
Where the concurrent user limit is reached, or where someone attempts a maintenance program while others are logged in, there is now a list of who is logged in, and when they logged in. Additionally, a more robust method of checking means that snapshots will not be performed or restored if any data file is in use, re-indexes and packs will skip any files in use and the user is informed which files are in use.
The patient selection screen for user letters has been updated to include the patient forename and date of birth. The screen is larger with longer lists. The cursor will now move onto the next patient available while moving through patients, rather than going back to the top.
Organisations can now be linked to health authorities, to enable the recording of a GP surgery's PCT.
Problems encountered with editing next visit dates and clinic codes have now been resolved.
‘Walk-in’ messages have been improved to include the proposed new clinic date and clinic description, with extra patient information.
Walk-ins, batch and DNA dosing are prevented for old visits.
When dosing individually within the batch screen, the cursor now moves to the next patient in the filtered list rather than going back to the top.

Dawn AC Version 7

As described at our recent User Group, we have commenced work on a completely redesigned Dawn AC. Version 7 will also be based on robust client server technology using a web browser front end with Microsoft SQL Server database.

The system will also be able to support national, regional or district wide access enabling primary, secondary and tertiary care centres to share the same data but subject to compliance with the latest data protection requirements such as HIPPA.

Forthcoming Meetings

If you are attending the following meetings would be pleased to see you.

British Society of Haematology, Manchester, UK, 11^th to 13^th April 2005 on Stand 11.

The Anticoagulation Forum, Orlando, Florida, USA, 5th to 7^th May 2005.

American Society of Health Systems Pharmacists, Boston, USA, 13^th to 15^th June 2005 on Booth 551.

International Society of Haemostasis and Thrombosis, Sydney, Australia, 8th to 11^th August 2005 on Booth 502.

Syd Stewart

End of Newsletter

“We Really Care"

“Dawn AC is an easy to use, adaptable, powerful, and comprehensive PC based Anticoagulation Software System. It covers the complete oral anticoagulation life cycle with Induction and Maintenance Modules “

“Lancet Nov 7th 1998, Multi-centred Randomised Trial using Dawn AC shows computer aided dosage leads to INR control 20 to 30% better than medical experts”