Appendix 2

Patient Counselling Checklist for Oral Anticoagulants (Warfarin)

Full Counselling
This will usually be done by the ward pharmacist / prescribing GP (or deputy)
To be filed in the Patients medical notes.
Patient Name:
Patient DOB: .
Hospital Number: .
Address: .
Please tick to confirm that you have counselled the patient on the following
points and given the patient the yellow Oral Anticoagulation Therapy (OAT)
pack.
Date
Initials
______________________________________________________________
1. Compliance
Advise taking at the same time (6pm) each day
Missed doses-take as soon as remember
Do not double up doses

2. Reason for taking warfarin

Anticoagulant decreases ability of blood to clot
Individual indication: DVT / PE / AF / valve replacement etc.
Reduces the risk of clots forming/getting larger
Side effects

3. Obtaining a supply
Explain available strengths, colours
Where/how to obtain a supply
Travelling abroad

4. Need for regular monitoring of INR

What is the INR
Regular monitoring
Anticoagulant clinic, GP surgery, postal system
Explain yellow OAT book

5. Effects of poor anticoagulant control

Bleeding Symptoms -severe bruising, tea-coloured urine, dark, tarry stools,
coughing up blood (coffee-stained), severe headache, prolonged bleeding.
Recurrence of thromboembolism new pain, shortness of breath, pain,
swelling redness in an extremity, sudden inability to speak, slurred speech,
sustained numbness or weakness in arm/leg

6. Action to take if bleeding/bruising occur

Urgent check of INR

Appendix 2

7. Appropriate action if patient unable to take warfarin

What to do with after vomiting or diarrhoea

8. Starting, stopping and changing the dose of warfarin

Loading doses
Duration of therapy
Altering dose in response to INR

9. Drug/Food Interactions
Over-the-counter medicines:
Aspirin
Ibuprofen
Health Shop herbal remedies
Ask pharmacist/GP for advice
Prescribed Medicines:
Importance of notifying changes
Starting/stopping interacting medicines
Foods high in Vitamin K:
Importance of moderation with Vitamin K rich foods (green vegetable)
Diet should be well balanced

10. Alcohol Intake

Importance of moderation
Avoid binge drinking
Max: 2 units per day

11. Contraception, pregnancy and HRT (if relevant)

12. Surgical procedures/admissions (including dental work)
13. Injections
Avoid intramuscular injections

14. Information for Dentists

Need to inform dentists and podiatrists if patient on warfarin

15. Leisure Activities

Avoid sports and activities which may result in a serious fall or injury