Point-of-Care INR Determination, Coumadin Dosage Changes, and Use of a Historical, Self-Updating Database in a Prison

Abstract

Coumadin is the most dangerous medicine in common use in primary care medicine as well as in the correctional setting. In the Maryland Division of Correction's Eastern Correctional Institution, a multivendor collaboration between the medical director and a clinical pharmacist maintained a point-of-care, finger stick international normalized ratio determination using a portable monitor. With an anticoagulation clinic protocol as a guide, changes are considered in the Coumadin dosage and made through the usual procedure. Results are recorded in an electronic patient health record and tracked in a database that shows the current data page as well as updated historical data for each inmate.

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions

“…After initial uses of PHR systems in the early 2000s, new data elements such as appointments, preferences, and system settings emerged. More recently, PHR data included reminders (eg, appointment reminders [ 51 , 99 , 101 ], medication reminders [ 93 , 110 , 114 ], screening and laboratory work reminders [ 42 , 46 , 110 ], immunization reminders [ 29 , 30 , 55 , 57 , 82 , 90 ], preventive care reminders [ 21 , 59 , 60 ], and health maintenance reminders [ 82 ]), in addition to alerts [ 22 , 76 , 77 , 99 ], identification of personal health goals [ 19 , 24 , 38 - 40 , 43 , 72 , 74 ], and disease prevention [ 76 , 77 , 99 , 110 , 115 ]. Tracking and monitoring data via e-journals [ 82 ] and diaries [ 50 ] also became available.…”