Thoughts on monitoring and overmonitoring

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Professional Dingbat
Nov 4, 2012
Queensland, OzTrayLeeYa
interesting, thanks for posting that.

In particular to me the following stood out:
Doctors overcorrect too often. Warfarin dosing is a common and frightening example. Over the years I have often seen the practice of ordering based on only the current dose and the current PT/INR value.

Say the INR is 1.5 (should be 2-3) on 5 mg of warfarin. The doctor orders 7.5 mg daily without seeing that two months ago when the patient was given that dose, the INR shot up to 3.9. Even electronic medical records sometimes display the current value (and/or the place to order and “sign off” on it) in a whole different area from where we see historical values and dosing (Any reference to Greenway or eClinicalWorks here is purely coincidental). This causes a risk for overcorrection ....

and we see many examples in our own anticoagulation forum.

I guess his "driving in snow" example is what I call "keep a steady hand on the tiller" (which is my sailing way of saying "don't try to correct for every wave, just keep the average direction on course"

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