The
user can easily override all dose and review period suggestions.
INRstar can be set up to dose patients in any way that you like. You can
specify that doses are calculated using single strength tablets or by
using a combination of different strength tablets. If you prefer to use
single strength tablets you can specify which strength tablet to use or
you can let the system decide a suitable strength. You can also specify
whether half-tablets should be included in the dosing schemes. This can be
done on an individual patient basis or can be set to apply to all patients
on the system. You can also set the program to include or exclude the new
0.5mg strength warfarin tablets.
Simply click on the target INR (or treatment duration) that you would like
to change. Enter your preferred figure in the box.
Clear
the Use half tablets check box.
Yes. You can achieve this in two ways:
Firstly, you can allow a greater tolerance to variation from the target
INR. The program would then allow this patient’s INR to fluctuate more
widely from the target INR before a dose adjustment was suggested.
Secondly, you can adjust the degree of dose adjustment that the program
will suggest in response to a change in INR. This would be appropriate for
a patient who seemed very sensitive to dose adjustments. By reducing the
dosing adjustment sensitivity for this patient the program will suggest
smaller increases in warfarin dose when the INR result falls below target.
In
this case you could set a fairly “strict” tolerance for low INR results
and a more “relaxed” tolerance for higher INR results.
For
this patient use the tolerance controls to set a tight tolerance for high
INR and a more generous tolerance for low INR results.
Position the mouse pointer over the actual
dose in which you are interested.
Holding down the left mouse button briefly
will display a dosing schedule screen that shows the exact dosing
instructions that the patient would have received.
You can choose to view the dosing schedule can
be displayed in text or graphically by clicking on the relevant tab at the
top of the dosing schedule screen
Any
comments added at the time of a treatment will appear in truncated form in
the Comments column of the treatment area. To view the full text of a
comment select the relevant comment and briefly hold down the left mouse
button. A text box will appear displaying the full text of the comment.
This text box can be resized or moved to suit your computer’s screen and
INRstar will remember the new size and position.
To delete a saved
treatment you must have supervisor status (see setting up a user).
To delete a treatment
click on the date of the treatment to be deleted
Press the DELETE key.
The
treatment selected will be highlighted in red and you will be prompted to
confirm the deletion.
All unprinted treatments are stored as a list
called the Doctor’s worksheet.
To
view the Doctor’s worksheet click on the Worksheet button. A list of
patients with unprinted treatments will appear. Double-clicking on a name
will take you to that patient’s anticoagulation record screen.
INRstar has a wide selection of built-in audits and reports. Some apply to
individual patients and others to all your patients as a whole. To view
the audits for an individual patient you will first need to have the
patient’s anticoagulation record screen displayed. Then click on the
charts button to display the patient audit screen.
Clicking on the tabs at
the top of the audit screen will display different audit charts.
The INR results chart
shows the relationship between warfarin dose and INR for this patient. The
last 10 INR results with the corresponding warfarin dose are displayed.
The Target INR is indicated as a dotted line.
The Audit chart shows the
percentage of INR results that are in-range, below range or above-range.
These figures apply to all the results stored on the system for this
patient. In-range is defined as within 0.5 INR units either side of the
INR target. This criterion can be changed via the program options screen.
The Dose override rates
chart shows the number of times that the suggested warfarin dose has been
overridden by the user. This gives an indication of how “difficult” this
patient is to control. If the override rates are high then it might be
appropriate to alter the dosing algorithm settings for this patient.
If the dose is being
amended downwards frequently then it would be appropriate to reduce the
dosing sensitivity for the patient and vice-versa.
The Review override rates
chart gives similar information for user overrides of suggested review
periods.
Click the Print button to
print a chart or click the Hide graphs tab to exit the patient audit
screen.
For practice-wide audits and reports click the
charts button (as above) without having an individual patient’s
anticoagulation screen displayed.
The practice audit screen will be displayed.
Consult the main program documentation for full details on the individual
audits and reports available from this screen.
Reports can be made to include all dates or to apply to specific
date-ranges by clicking the appropriate option buttons. Similarly, the
reports can be restricted to currently active patients only or to include
all inactive patients as well.
All audits and reports can be printed or exported for further analysis.
You can add, or remove, your own diagnoses to
the list of standard diagnoses held in the system. You will need to add a
default target INR and treatment duration time with the new diagnosis.
Click on the practice options button and select Diagnoses or select Diagnosis
options from the Options menu.
Click on Add and enter your new diagnosis in the box. Press
the TAB or Return key. Enter your target INR and treatment duration into
the relevant boxes. Click Save to save your new diagnosis.
You can edit the
target INR and treatment duration figures associated with any diagnosis
within the system. This might be necessary if a new target INR is
recommended by an authority (such as the British Haematological Society).
To edit an existing
diagnosis, click on the Practice options button and select Diagnoses or
select Diagnosis options from the Options
menu.
Select the diagnosis to
edit from the list. Click in the box containing the target INR or
treatment duration that you want to edit. Enter your new figure in the
box. Click Save.
Note:
Changes made to an existing diagnosis will apply to all new patients who
are given the diagnosis. Patients already on the system will need to have
their existing target INR edited individually.
Yes,
the program is supplied on an evaluation basis. This means that you can
use the program for a period of three months without charge. If you decide
to continue to use it after this period you will need to register your
copy and pay the annual licensing fee. The evaluation copy allows you to
add 50 patients to the system.
No, you only need to
register if you decide to continue using the program, or if you would like
to add more than 50 patients during the evaluation period.
When registering the
program you can specify how many patients you would like to add to your
system. The licence fee varies depending on this.
Licensed users receive free software upgrades when new versions of the
program are released and free technical support via fax and email.
Click on the Register button
from the welcome screen.
Complete the on screen registration form, click on Print to
print a copy and then fax it to us. A registration code number will be
faxed back to you and an invoice issued. Entering the registration number
will register your copy of INRstar for the agreed licence period.
Click on the Add New
Patient button or select Add a New Patient from the Patient
menu to access the New Patient form. This section of the New Patient form
is for name, address and DoB details. Use the Notes field to add any
comments that might be relevant for this patient. To add details of the
diagnosis and Target INR for your new patient, click on the Diagnosis
tab at the top of the New Patient form. Select the relevant diagnosis from
the list. The appropriate target INR and duration of treatment will be
displayed automatically.
Enter the date when
treatment started in the Start date box. Clicking on the little arrow next
to the date box will display a calendar, which can be used to select the
correct starting date.
For patients already
taking warfarin, enter the date of the last INR test, the latest INR
result, the current warfarin dose (in mg/day) and the last review period
(in days).
For patients for whom you
are initiating warfarin treatment, enter the pre-treatment INR and click
on the Initiate treatment check box.
For
full details on initiating treatment consult the main program
documentation.
To alter a patient
details simply click anywhere in the patient information area at the top
of the anticoagulation record screen. You will be prompted to confirm that
you want to edit the patient details and the patient details screen will
be displayed.
This screen is similar to
the New Patient screen and allows you to alter any of the information
displayed.
Click on Save
to save the new information or click Quit if do not wish to save the
alterations.
Depending on the size
and resolution of your monitor it is possible that the weekday names can
be out of alignment with the dosing information when viewing the dosing
schedule screen. To fix this, click on one of corners of the dosing
schedule display and resize it by dragging with the mouse until the
alignment is correct. INRstar will remember the new size of the display
and it will remain aligned each time you use the system.
You
can also move an INRstar3 window to another part of your screen if you
wish. INRstar3 will remember the new position.
You
are either trying to edit the details of an old treatment or you do not
have the correct user privileges to be able to override dosing
suggestions. Each user has a set of permissions that allow access to
different parts of the system. Some users may not be allowed to alter dose
or review periods. The user access privileges are set up in the Users
screen.
You
can re-print the current treatment by clicking on the date of the
treatment you wish to reprint. Click on the Reprint button to reprint the
treatment.
INRstar3 is designed
to be used on a network so that all users share the same patient data.
When each copy of the program is installed onto a computer it configures
itself as a single user system. In order to set up a network two main
steps need to be taken.
1. Set up the central
database.
2. Connect individual
users to the central database.
Consult the main program documentation for full details on setting up a
central database and connecting individual users.
It is easy to change your
own password. If you have forgotten it then the supervisor can give you a
new password which you can then change.
To change your password:
Ø
Display the
users screen by clicking the Add or edit a user button.
Ø
Click on
the Change password button.
Ø
Your user
name will be displayed.
Ø
Enter your
existing password.
Ø
Enter your
new password (must contain at least 5 characters).
Ø
Re-enter
your new password for confirmation.
Click
the OK button.
To add a doctor:
Ø
Click on
the Set Program options button 
Ø
Select the
Practice tab.
Ø
Click
Add Dr. button and enter the doctor’s name. Hit Return and
confirm the name by clicking Yes.
Ø
Click the
Save button to save your changes.
To associate a patient with the doctor:
Ø
If you are
associating an existing patient with a doctor Find the
patient record.
Ø
When this
is displayed click on the top section of the screen that contains the
diagnosis information and confirm you wish to edit their details.
In
the Patient tab there will be a list of doctors. Select the doctor you
require and click the Save button.
Return
to top
I've tried to log into
INRstar but I get a message telling me tat the licence has expired. I have
paid my licence fee and other computers on our network can still use access
the central database and these do not say their licence has expired. What's
happened?
It is likely your copy of INRstar has
lost it's connection to your database. To cure this problem follow these
instructions:
-
Select Start
→ Search (or Find)
→ Files or Folders.
-
Type inrstar3.ini and then hit the
return or enter key.
-
If more than one file is returned,
please contact our Technical Support staff.
-
Double left click on the file to
open it.
-
The first three lines should look
something like this:
