Warfarin Care Clinic
Information for Patients
REF NO:
qml.com.au
WELCOME TO THE WARFARIN CARE CLINIC
Your doctor has registered you in the QML Pathology Warfarin Care Clinic so that we can monitor your
blood and keep your warfarin dosage at a safe level.
Currently QML Pathology cares for over 10,000 patients throughout Queensland and northern New South
Wales.
The Warfarin Care Clinic is not funded by Medicare or any other funding source. We will require your full
cooperation to make this service run efficiently and effectively.
CONTACT DETAILS*
Ph 1300 661 963 or warfarincare@qml.com.au
Mon-Fri: 10:00am to 3:00pm
Sat: 10:00am to 1:00pm
* Always provide your reference number with any communications. Have a pen and paper (or your notebook) ready to record
your results and/or dosage changes, or other information. If you are due to have a blood test, then write any new information on
your request form. Make sure one of the questions on your request form is marked with “Yes” so the changes will be forwarded
to the QML Pathology Warfarin Care Clinic.
Do not send SMS.
WARFARIN CARE CLINIC FEES
Registration Fee
The Warfarin Care Clinic registration fee is a one off fee billed at the time of your first INR test as a
Warfarin Care Clinic member.
Annual Fee
The Warfarin Care Clinic annual fee will be charged on the 1
st
of November of each year via invoice from
our accounts department.
Concessions and Exemptions
Concession rates will apply to all patients over the age of 65 and under the age of 18.
DVA and Health Care Card holders will also be eligible for concession rates.
QML Pathology will bill the DVA directly for eligible DVA card holders.
Nursing home residents are exempt from Warfarin Care Clinic fees.
qml.com.au
Warfarin – what you need to know 1
What is warfarin? 1
How does it work?
1
Reasons for warfarin treatment 2
Duration of warfarin treatment 2
Stopping warfarin 2
When storing warfarin 2
Side effects 2
How will I know I have the right dose of warfarin? 2
What if I miss a dose? 3
Dose reminders 3
Useful aids 3
INR blood test 4
What does INR measure? 4
Some typical INR ranges 4
Testing times 4
Reminders when you miss your test 4
What affects the INR? 4
Guidelines for INR control 5
Medicines 5
Vitamin, mineral and herbal supplements 5
Common herbal medicines that may interact with warfarin 6
Dietary guidelines 6
Alcohol consumption guidelines 6
Exercise guidelines 6
Receiving your INR blood test results 7
Receiving your INR dose result by SMS 7
How does the SMS service work? 7
Request forms and rule 3 exemption 9
Staying safe while on warfarin
10
What to do when bleeding occurs 10
What to do when travelling 11
What to do when undergoing medical procedures, surgery or dental work 12
Essential warfarin information 13
Table of contents
Warfarin
1
Warfarin – What You Need To Know?
Warfarin is a medicine used to treat or prevent
blood clots (thrombosis). It is taken in tablet form,
once per day. There are two brands of warfarin:
Coumadin® and Marevan.®
Dindevan® is another brand of medicine only
used in those who are allergic to warfarin. It is
taken twice daily, unlike warfarin which is taken
once a day. The information in this leaflet applies
to all three medicines.
It is important that you always take the same
brand of warfarin. Make sure you always have
enough medicine, so that you don’t run out.
O
Do not swap from one brand to the other.
O
Do not combine these brands. (This may affect
the blood test result).
HOW DOES IT WORK?
Warfarin is a type of blood thinning medicine known
as an anticoagulant (anti-clotting). These types of
medicines lengthen the time it takes for your body to
form a blood clot. This means it thins the blood out to
lower the risk of blood clots forming that can cause a
stroke or a blockage in your lungs or veins.
The aim of treatment is only to slow down the clotting
process; if the blood was prevented from clotting
altogether this would cause bleeding. Bleeding can
be a potential risk when taking this medicine.
Warfarin works by stopping the blood clotting factors
from functioning. It does this by blocking the action
of vitamin K. The body uses vitamin K as a final step
in creating blood clotting factors (which are made in
the liver). You get vitamin K from your diet. The net
effect of warfarin in your body is a balance between
the amount of vitamin K and warfarin in your system.
(Refer to “INR Blood Tests” for further information
about the impact of vitamin K.)
Once you begin taking warfarin it will take several
days to take effect. Similarly it takes some days
to wear off once you stop it. This is because the
warfarin-affected blood clotting factors need to work
their way in and out of your body.
COUMADIN
®
TABLETS
Coumadin® tablets are available in three
strengths.
Each strength has a different colour to distinguish
it from the others.
Be sure you are taking the correct tablet by
checking the colour and strength.
MAREVAN
®
TABLETS
Marevan® tablets are available in three strengths.
Each strength has a different colour to distinguish
it from the others.
Be sure you are taking the correct tablet by
checking the colour and strength.
1 mg
Light Tan
Scored with the
number 1 and
Coumadin on
one side, plain
on the other
2 mg
Lavender
Scored with the
number 2 and
Coumadin on
one side, plain
on the other
5 mg
Green
Scored with the
number 5 and
Coumadin on
one side, plain
on the other
1 mg
Brown
Scored bevelled
edge, with M1
marked on one
side, plain on
the other
3 mg
Blue
Scored bevelled
edge, with M3
marked on one
side, plain on
the other
5 mg
Pink
Scored bevelled
edge, with M5
marked on one
side, plain on
the other
REASONS FOR WARFARIN TREATMENT
Warfarin can be used for:
• Deep Vein Thrombosis (DVT)
• Pulmonary Embolism (PE)
• Heart conditions: Atrial Fibrillation (AF), valve
replacements (these can be metallic/mechanical
or tissue)
• Stroke (CVA)
• Other blood clotting conditions.
DURATION OF WARFARIN TREATMENT
Your personal health conditions will guide the
doctor’s decision regarding how long you will need
to stay on warfarin treatment.
• Up to 6 months: Simple DVT/PE, valve
replacement (tissue), AF (if temporary)
• Up to 24 months: Major DVT/PE
• Life-long: AF, Mechanical heart valve, recurrent
or
life-threatening clots
If your treatment is NOT life-long, you will be asked
to see your doctor when your warfarin duration is
due for review.
STOPPING WARFARIN
If any doctor ceases your warfarin permanently,
please contact the Warfarin Care Clinic so we
can close your file.
We will require the date you have ceased and
the name of the doctor who has asked you to
cease your warfarin.
WHEN STORING WARFARIN
P
Keep tablets dry.
P
Keep in a cool dry place where the temperature
stays below 30˚C.
O
Do not leave the tablets in the car or on a
window sill on a hot day.
P
Keep out of reach of children.
SIDE EFFECTS
It is important to speak with your doctor to ensure
you fully understand the impact of taking warfarin.
Side effects from warfarin are quite uncommon.
The most serious side effect of warfarin is
bleeding.
This bleeding might be obvious. For example:
• A nose bleed
• Bleeding from cuts or from gums
• Bruising
• Red or dark brown urine
• Red streaked or black bowel motions or
• Heavy periods.
However, bleeding in deeper tissue can be harder
to identify and may present as pain, swelling,
severe or persistent headaches, dizziness or
weakness. You should contact your doctor if
any of these signs or symptoms occur.
Other less common side effects are hair loss,
skin rashes, headache, nausea, vomiting and
diarrhoea.
P
If you develop any symptoms or side effects,
speak with your doctor.
P
Notify the Warfarin Care Clinic about any
symptoms and all treatments being taken. Our
dosing doctors need this information to ensure
your management is safe and appropriate.
HOW WILL I KNOW I HAVE THE RIGHT DOSE
OF WARFARIN?
You will require blood tests (known as INR) to
check how well warfarin is working. At first the
blood tests will be done every second or third day.
When the blood level is stable, the frequency of
testing will reduce to weekly, fortnightly and then
longer intervals. You will require regular blood
testing as long as you remain on warfarin.
Warfarin
WHAT IF I MISS A DOSE?
If you remember within six hours, then take the dose.
If you are unsure or remember after this time, then
take your normal dose the next day. Do not take a
double dose in order to make up the missed dose.
If you miss one dose more than a week before your
blood test, it will not reflect in your blood test, and
you need not mention it. BUT if you have missed
more than one dose, you should mention this.
If you miss one or more doses within a week
of your blood test (INR), please ensure you
note this on the form so we can adjust your dose
accordingly.
O
Do not take a double dose of warfarin in order
to make up a missed dose.
P
Make a note on the form if you miss one or
more doses within a week of your scheduled
blood test (INR).
DOSE REMINDERS
Here are some helpful hints that might assist you in
remembering to take your warfarin:
• Put a reminder note in a prominent place, e.g.,
fridge, bathroom mirror etc.
• Use a dosette box placed where you will see it.
Refill this with the latest dose after each phone
call, and this will help you remember the dose
• Keep a supply of tablets at work so you can take
them at work if you forget before you leave (if
you do this, rotate the bottles with those at home
so expiry is not an issue)
• Use an alarm set for your usual time
• Set a reminder on your work calendar – this
is good for your next test date too. Include
a reminder to get your Rule 3 Exemption form
signed by your doctor every 6 months.
IMPORTANT INFORMATION
• Warfarin only reduces your risk of another
event or clot - it never eliminates this risk
(even when the INR is within your range).
• Warfarin is a dangerous medicine, if taken
incorrectly.
• You can be at risk of haemorrhage if you have
a weak bleeding point in your body, even when
the INR is within the desired range.
USEFUL AIDS
Tablet cutters
Tablet cutters are available through your pharmacy
to assist in cutting your tablets to provide the
correct dosage
This groove is present to allow the tablet to be cut.
The tablet cutter is placed here to cut the tablet in half.
O
Do not cut tablets more than once.
Webster packs
If you are unable to deal with a large number of
tablets, or if you have difficulty cutting tablets,
speak with your pharmacy about a Webster Pack.
These packs set out your tablets in the exact
doses that you need for seven days. Usually they
are packed by the pharmacist on a fixed day of
the week.
Due to the fact that your warfarin doses may
change after an INR test, your Webster Pack
should be packed from one INR test date to the
next. Therefore if you are already receiving a
Webster Pack for your medicines, you should
request your warfarin in a separate pack.
Please note: This may incur a small fee from the
pharmacy. Please provide QML Pathology Warfarin
Care Clinic with the name and phone number of
your pharmacy and we will contact them directly
with your doses. If your pharmacy is unable to
provide this service, QML Pathology Warfarin Care
Clinic can advise of a pharmacy who can.
Identication bracelet
It is recommended that patients taking warfarin
wear an identification bracelet. This is important
should you be involved in a medical emergency.
Tablet cutter
3
INR Blood Test
WHAT DOES INR MEASURE?
You will require blood tests to check how well
warfarin is working. At first the blood tests will be
done every second or third day. When the blood
level is stable, the frequency of testing will reduce
to weekly, fortnightly and then longer intervals.
You will require regular blood testing as long
as you remain on warfarin.
The blood test result is given as an International
Normalised Ratio (INR). This is a measure of the time
it takes for your blood to clot. It is like a warfarin level,
and is used to adjust the warfarin dose.
• The higher the INR, the thinner the blood, and the
less warfarin you need.
• The lower the INR, the more likely it is that you will
develop a clot, so you may need more warfarin.
• The goal is to find the right dose of warfarin
for you so that your INR result is kept within a
target range. Your individual target range is
determined by your reason for taking warfarin
and other health factors.
INR targets are a range rather than a single figure
because INRs tend to fluctuate and a range allows
us (and you) more flexibility. This flexibility will give
you a longer break between blood tests.
Some typical INR ranges:
• INR 2-3 Deep Vein Thrombosis(DVT)/
Pulmonary Embolism(PE)/Atrial
Fibrillation(AF)
• INR 2.5-3.5 Mechanical valves/recurrent DVT’s/
major PE’s
An INR > 4.5 means your blood is too thin
An INR < 1.5 means your blood is too thick
TESTING TIMES
Initially your blood test will be performed every
2-3 days until the INR comes into range. Once in
range, tests will be done weekly, and then if the
INR stays in range, the time between tests will be
gradually increased to a maximum of 8-12 weeks.
We recommend attending a QML Pathology
collection centre between 8am and 9am on the
day of your test so that we can receive and check
your INR test results as soon as possible.
Reminders when you miss your test
We do understand that you can forget to test from
time to time. However, we would ask that you do
test on the correct date where possible. If you do
forget to test we may follow up with you by sending
you a reminder SMS (if you receive your results via
SMS), or phone you, or you may receive a friendly
reminder letter in the mail. A copy will also be sent
to your referring doctor. Please go for your test
immediately upon receipt of the reminder letter or
notify us of any problem if you are unable to test.
If you do fail to test, a second letter will be sent
advising you that your warfarin monitoring may be
ceased and returned to the care of your doctor
if no response is received by us. Your referring
doctor will also be contacted following this letter.
Again, please remember to contact us if there is
any problem that prevents you from having your
INR test.
WHAT AFFECTS THE INR?
A number of metabolic and lifestyle factors can
affect your response to warfarin. If your INR
control is unstable, please consider the
following points:
• Check whether you are taking the correct
brand of warfarin
• Check the expiry date
• Check whether you have missed any tablets
• Check you are taking the correct dose. If in
doubt, check your calculations with our staff
• Are you taking any other medicines? Some
common culprits are antibiotics, herbal or vitamin
supplements, diet aids, pain relievers or rubs
• Has your general health changed, e.g.,
diarrhoea, loss of appetite, heart failure etc?
• Have you had any gastrointestinal upsets?
• Have you changed your normal level of
alcohol consumption?
• Have you developed a fever?
• Have you had a notable weight change?
• Has your diet changed significantly since the
last test?
Warfarin
GUIDELINES FOR INR CONTROL
Your INR is a balance between the amount of
vitamin K and warfarin in your body. It is also
affected by the metabolism of warfarin. Warfarin
metabolism is influenced by many prescription
medicines and over-the-counter products.
Some medicines can increase the effect of
warfarin while others may decrease it. QML
Pathology must be advised of any medicine
changes that will last more than three days. You
must do this to ensure that the next test date is
reviewed in line with the medicine changes.
Medicines
Pain relief
For simple pain relief, use paracetamol, i.e.,
Panadol/Panamax. If taking four or more
paracetamol tablets daily for three days or longer,
please advise QML Pathology.
Some patients are on regular aspirin as directed
by their doctors but DO NOT take extra aspirin
for pain relief. Aspirin is also a blood thinner but it
works in a different way to the warfarin. Be aware
that some cough mixtures or flu medicines contain
aspirin.
Almost all pain relievers can increase the INR
including:
• Anti-inflammatory medicines
• Liniment rubs
• Endone, Tramal and other narcotic pain
relievers.
The only pain relief that will not affect the
INR is heat. A wheat bag can be useful, but be
careful not to burn yourself.
Please note - this does not mean you cannot
take these medicines if needed, but do notify us.
With additional tests we can often stabilise your
INR again once you are on a regular doses of
painkillers.
General Medicines
Some over-the-counter medicines can increase
the INR:
• Thrush tablets and oral gels (Daktarin, Diflucan)
will markedly increase the INR
• Cough mixtures, mouth ulcer gels, Vicks Vapour
Rub, tinea treatments and others.
Antibiotics
Nearly all antibiotics affect the INR (either increase
or decrease), some dramatically. If you start ANY
antibiotic you need to have an INR done around 2-3
days after starting.
Vitamin, mineral and herbal supplements
• Check vitamin K content of supplements (do not
confuse vitamin K with potassium which has the
chemical symbol of ‘K’). The chemical name of
vitamin K is phytomenadione.
• Minerals such as iron, zinc and magnesium
should be taken two hours apart from warfarin
as they can affect its uptake.
• Vitamins C and E in large doses can affect the
absorption of vitamin K, which in turn alters the
INR levels.
• Herbal supplements (mostly those containing
plant extracts) can contain unknown quantities
of vitamin K, which can make your INR unstable.
• Be cautious with herbal teas; some contain
coumarin derivatives, e.g., tonka beans, meliot
(sweet clover), sweet woodruff and camomile.
Green teas contain vitamin K.
• Consult your doctor and the Warfarin Care
Clinic before commencing any supplement.
• Some herbal supplements may combine with
warfarin to stop blood clotting by ways other
than increasing the INR (e.g., by stopping
platelets from working).
Contact the Warfarin Care Clinic if:
• you have any changes to medicines that will last more than three days. (This includes pain relief
medicines and rubs, antibiotics, and anti-inflammatory medicines).
• Your doctor changes a dose of any of your current medicines or if you stop any medicines. (An extra
blood test may be necessary).
5
Common herbal medicines that may interact
with warfarin
Note that these substances may not be a problem
for everyone taking them. But if your INR is
unstable, these may be possible causes. You
should have your INR checked soon after you
commence any of the following:
• Cranberry
• Co Enzyme Q10
• Dan Shen
• Devil’s Claw
• Dong Quai
• Fenugreek
• Fish Oils (Omega 3)
• Garlic
• Ginger
• Gingko Biloba
• Ginseng
• Glucosomine
• Horse Chestnut
• Red Clover
• Saw Palmetto
• St John’s Wart
• Sweet Clover
Dietary guidelines
Consistency in diet is important. Avoidance of
vitamin K is not recommended, but eating the
same amount of foods containing vitamin K will
allow us to find the dose of warfarin that matches
your dietary intake.
Foods that are high in vitamin K are green leafy
vegetables, i.e., spinach, alfalfa sprouts, broccoli,
lettuce, cabbage, coriander, parsley, soya beans,
and canola and olive oils.
• You can eat these foods in moderation; you do
not have to cease eating them completely.
• Please note: broccoli, lettuce and cabbage have
less vitamin K than spinach or sprouts.
Sometimes, if your INR is high, we will ask you to
eat some of these foods high in vitamin K, so it is
advisable to keep some (frozen vegetables are
handy) in the house in case of this.
Dietary drinks, e.g., Tony Ferguson or Optifast, are
vitamin K supplemented. Advise us immediately
if you start on these, and always tell us when
you stop as they have a substantial effect on the
INR. Ensure and Sustagen are also vitamin K
supplemented and we should be notified when
using these.
• Consistency in diet is important.
• Avoid crash diets.
• Avoidance of foods with vitamin K is not
recommended.
• Contact the Warfarin Care Clinic when you
start and stop dietary drinks such as Tony
Ferguson, Optifast, Ensure and Sustagen.
Alcohol consumption guidelines
Alcohol increases the effect of warfarin. If you
drink a small amount of alcohol on a regular basis,
it is usually possible to adjust your warfarin dose to
allow for this. Drinking large amounts of alcohol will
signicantly increase your risk of bleeding.
• Alcohol increases INR.
• A maximum of two standard drinks is advised.
Exercise guidelines
Exercise is encouraged in moderation.
Changes to your activity level should be gradual.
If you experience any ill effects including pain,
shortness of breath or dizziness you should
consult your doctor.
Warfarin thins the blood, thus making it more likely
that you will bruise or bleed if you are injured.
Therefore you should avoid all contact sport and
activities with risk of serious injuries such as hang
gliding or rock climbing. Normal sexual activity
will not usually cause problems.
Warfarin
Receiving Your INR Blood Test Results
Communication about your INR blood test results
is a two-way street. You will need to ensure
you have notified the QML Pathology Warfarin
Care Clinic about anything that might affect your
test result. When the INR blood test has been
completed, the Warfarin Care Clinic will need to
notify you of your result and any changes to your
medicine.
When you have your blood test, a special request
form needs to be sent in with your INR. This form
has a number of questions that the QML Pathology
Warfarin Care Clinic dosing doctor needs to know.
It also allows you to communicate with us about
any important changes.
Please complete ALL questions.
If you write ANYTHING on the form that you need
staff in the QML Pathology Warfarin Care Clinic to
know, you should mark at least one of the questions
as yes. Please ask the collector if you require
assistance completing the form.
The collector can give you a blank form to take home
and use at the next test, or you can obtain a form
from the QML Pathology website qml.com.au.
If you test after 12.00pm, it is unlikely that you will
receive results that day. We recommend attending
a collection centre between 9.00am – 12.00 noon.
QML Pathology Warfarin Care Clinic may
telephone you if there are important changes to
your dose; otherwise you will receive your results
by SMS or other means (as nominated).
• Ensure your contact details, phone numbers and
postal address are up to date at all times.
• Mobile phones should be switched on and/or
other phones should have a suitable answering
service if you are unable to attend to these.
• Attend the collection centre between 9:00am
-12:00pm to receive your results on the same day.
RECEIVING YOUR INR DOSE RESULT BY SMS
Undergoing warfarin therapy can greatly encroach
on your life and freedom. To help alleviate
this, QML Pathology Warfarin Care Clinic has
implemented an SMS results system. It allows you
to keep track of your dosage requirements, no
matter where you are (as long as you are within
your service provider’s mobile network area).
If you register for the SMS service, you will be able
to receive your results and reminder messages
via SMS text message to your mobile. You can
nominate another person (carer or family member)
to receive the SMS however this person must be
comfortable in sending SMS text messages on their
mobile phone to use this service.
If there are any major changes, or if we have any
questions for you we will phone and talk to you
instead of the SMS. If we do talk to you, we can
also send the SMS if you wish to keep a record.
Simply ask the caller to do this.
HOW DOES THE SMS SERVICE WORK?
After you have your blood collection and INR
tested, a warfarin dosage will be prescribed. The
instructions will be sent via text to your nominated
mobile number.
The text message will show:
• Your name
• Reference number
• Date of test
• INR result
• Warfarin dose
• Next test date
Please note: Depending on your mobile screen
size, this message may extend across several
screens. You may need to scroll down to read the
full message.
7
When you receive your dosage via SMS there will
be a reminder at the end of the message asking
you to ‘Reply with your reference number, OR yes”
if you understand the instructions’. It is essential
that you reply to this message. Your reply will
inform QML Pathology Warfarin Care Clinic that
you have acknowledged receipt and acceptance
of the dosage instructions. (Refer to your particular
phone manufacturer’s instructions for directions on
how to reply to text messages.)
If you do not understand the SMS instructions,
or have any changes or questions, you
must contact the QML Pathology Warfarin
Care Clinic.
If you do not reply, we will assume you did not
receive the SMS and resend the SMS within 24
hours of your collection time. If you still haven’t
responded within 48 hours of your collection date
and time, a staff member from QML Pathology
Warfarin Care Clinic will call you to discuss the
results and SMS with you.
Please do not SMS back any questions, as
these cannot be answered by SMS.
We ask that you continue to take the same dose
until we contact you. All phoning out to patients is
done in order of clinical priority. We contact new
patients and those with abnormal results first, then
those with minor dose changes. If, however, you
do not receive your results within 2 - 3 days of your
test, you should call us on
1300 661 963 to confirm your INR and Warfarin
doses.
You can receive results (i.e., INR, warfarin dose,
and next test date) by:
• SMS to your mobile (this is the preferred and
most efficient option)
• Fax to your pharmacy if they pack your
medicines (we cannot send faxes to a private
residence)
• Mail to your postal address (only stable results
are sent by mail as there may be a delay in
delivery time dependent on your area)
• Phone call
We will always contact you by phone if your
results are abnormal.
If QML Pathology Warfarin Care Clinic repeatedly
do not receive a valid reply or we are unable to send
an SMS notification to your nominated mobile phone
number, we may review your continued enrolment in
our Warfarin Care Clinic. We will notify your referring
doctor if we consider this necessary.
• Results will be sent via text message to your
mobile phone.
• You can nominate another person (carer or
family member) to receive the SMS
• The patient or nominated person must be
comfortable using text messaging to use this
service.
• Do not SMS back any questions – these will
not be answered.
• If there are any major changes (or if we have
questions for you), we will phone and talk to you
instead of using SMS.
• If your result is abnormal or poses serious risk to
your health we will not send your dosage via SMS.
A staff member from QML Pathology Warfarin Care
Clinic will call you.
• Calls are prioritised in order of clinical significance.
Complete and return the “Warfarin Dosage by
SMS” form to register.
John Citizen
DOB/Ref Number
Tested 01/06/14
INR = 2.7
Dose instructions: 10.5 mg warfarin
Wed and Sat and 11.5 mg warfarin on
every other day
NEXT TEST: 01/07/14
Reply with ‘XXXX’ to confirm you have
read and understood your dose
QML Pathology – Warfarin Care Clinic
This is an example only; This is NOT your dose.
XXXX = Your Reference Number
SMS message example (Images of SMS messages used here
are examples only and do not pertain to your warfarin therapy).
WarfarinWarfarin
MEDICARE CARD NUMBER
PATIENT LAST NAME GIVEN NAMES
PATIENT ADDRESS POSTCODE
n
Is this a new postal address or contact phone number since your last test? Yes If “Yes” also tick Q7 below
TEL(HOME) TEL(BUS)
DATE OF BIRTH
QML REF NO.
SEX
REQUESTING DOCTOR (PROVIDER NUMBER, SURNAME, INITIALS, ADDRESS)
COPY REPORTS TO:
HOSPITAL/WARD
TESTS REQUESTED
CLINICAL NOTES
LABORATORY COPY
QML PRIORITY REQUEST
/ URGENT TEST
Ensure sample is sent in a
“Priority Specimen” bag.
Visit Type:
Rooms
Nursing Institution/Care Facility
Home Visit
HV Booking Number:_________
Collect Date Coll. Time Test Codes Attachments: Branch Ref. No. Lab. No. Description & Containers Collector
Yes / No (please circle)
If yes, no. of pages:
Received Date Rec. Time B/C Clinic
L U
A S
B E
Specialist Diagnostic Services Pty Ltd (ABN 84 007 190 043) t/a QML Pathology APA No. 000042
11 Riverview Place, Metroplex on Gateway, Murarrie Qld 4172. Ph (07) 3121 4444 (24 Hrs)
Was or will the patient be, at the time of the service or when the
specimen is obtained: (
✓appropriate box)
a. a private patient in a private hospital
or approved day hospital facility
b. a private patient in a recognised hospital
c. a public patient in a recognised hospital
d. an outpatient of a recognised hospital
yes no
PERSON DRAWING BLOOD
I certify that the blood specimen(s) accompanying this request
was drawn from the patient named above. I established the
identity of this patient by direct inquiry and/or by inspection
of wrist band and immediately upon the blood being drawn I
labelled the specimen(s).
Signature ...................................................................
MEDICARE ASSIGNMENT
(Section 20A of the Health Insurance Act 1973)
I offer to assign my right to benefits to the approved pathology
practitioner who will render the requested pathology service(s)
and any eligible pathologist determinable service(s) established
as necessary by the practitioner. In the alternate, I authorise
that APP to submit my unpaid account to Medicare so that
Medicare can assess my claim and issue me a cheque payable
to the APP for the Medicare Benefit.
X .......................................................... X ........ /........ /.........
Practitioner’s Use Only ..................................................................
(Reason patient cannot sign)
PATIENT’S SIGNATURE AND DATE
PATHOLOGY REQUEST
QML PATHOLOGY
WARFARIN CONTROL FORM
USE BLACK PEN ONLY
If patient has presented with a new, signed Rule 3 Form.
Attach Collection Label CL/005 to that form and use it to answer the standard questions.
Ensure dates and details are provided for YES answers, and you provide last warfarin dose
information. DO NOT use this form as an attachment. Refer SOP/CL/02/003.
FORM/HA/230_V14_Jul17_683018
Current Warfarin Dose Schedule: (Complete schedule AND current dose information)
Daily __________ mg OR Alternate Days __________ /__________ mg OR Other _____________________________________________________________________________________
Last dose of _____________ (number of ) x _____________ mg tablets (strength) = Total of _____________ mg. Taken on: _________ /_________ /_________ at __________________
QML PATHOLOGY/DOCTOR USE
PRIVACY NOTE: The information provided will be used to assess any Medicare benefit payable for the services rendered and to facilitate the proper administration of government health programs, and may be used to update enrolment records.
Its collection is authorised by provisions of the Health Insurance Act 1973. The information may be disclosed to the Department of Health and Ageing or to a person in the medical practice associated with this claim, or as authorised/required by law.
I confirm that the information provided on this form by myself to QML Pathology is based upon accurate responses. I have included any
medication changes as prescribed by my doctor. I understand QML Pathology will not be responsible for any adverse medical outcome sustained
by me as a consequence of providing QML Pathology with inaccurate information.
Signature:__________________________________
Date:_______________________________________
For a full list of our collection centres and their opening hours, please visit qml.com.au or call (07) 3121 4100
COLLECTION STAFF: IT IS YOUR DUTY TO ENSURE ALL QUESTIONS ARE ANSWERED AND APPROPRIATE BOX TICKED AND DATES ARE PROVIDED
QML Pathology Control – PT/INR AS REQUIRED – Rule 3 Exemption Wt: _______________ kg Ht: _______________ cm
Details for each issue/detail to a YES response Date began Date ceased
Important questions to ask the patient/carer (please answer all questions and provide details below to any ‘yes’ responses):
1. Are you new to the QML Pathology Warfarin Care Clinic? YES NO
2. Have you missed or withheld any doses in the last 7 days OR are you on a heparin (e.g. clexane) injection?
YES NO UNSURE
3. Has anyone other than QML Pathology (e.g. your doctor or yourself) changed your warfarin dose since your last test?
YES NO UNSURE
4. Since your last QML dosed test, have you been hospitalised for more than 1 day?
YES NO UNSURE
5. Since your last QML dosed test, have you had any changes to medicines other than warfarin for more than 1 day?
YES NO UNSURE
6. Since your last QML dosed test, have you had any notable changes to your health? (e.g. weight loss/bleeding/blood clots)
YES NO UNSURE
7. Other points of note (e.g. impending surgery, difficult collect, travel, holidays) or other relevant information for Warfarin Clinic?
YES NO
8. Are there any accompanying updated clinical notes or forms? Once scanned, send to Warfarin Clinic via internal mail.
YES NO
If 'yes' answered to any of the above, please give brief details, including any medicines and/or changes and reasons – YOU MUST PROVIDE DATES:
Note: Please read important
information on the back of this form.
PLEASE REMEMBER: The preferred time
to present for testing is 9am – 12pm
• Ensure you get your doctor to provide you with a new signed ‘Rule 3 Exemption’ form every six months.
• Medicare will not cover the costs of your blood tests unless you have a valid form.
Request Forms And Rule 3 Exemption
Usually when you have a blood test you need
to supply the collector with a pathology request
form signed by your doctor. This is required by
Medicare. When you are on warfarin, you need to
have blood tests frequently, so Medicare created the
‘Rule 3 Exemption’. This allows you to have numerous
blood tests using only one signed pathology request
form. Your doctor will provide you with the first
pathology request form that they must sign and
note ‘INR – Rule 3 Exemption’. This will last for
six months only. Once this time has passed, you
will need to visit your doctor for a new signed
‘Rule 3 Exemption’ form to continue having blood
tests. Medicare will not cover the costs of your
blood tests unless you have a valid form.
After QML Pathology receives the signed request
form from your doctor we will post out your Rule
3 Exemption Card that you should receive within
1 to 2 weeks. You should show this card to the
collector each time you test. This card is used to
complete an internal ‘INR QML Control’ form.
The ‘INR QML Control’ form contains questions
about your current warfarin dosing regimen and
allows us to collect information about current
medicine changes as well as any recent changes
to your health. Please complete the form
carefully. The collector may give you some
blank ‘INR QML Control’ forms where you can
complete the questions prior to your attendance
at a collection centre. Alternatively, you can
obtain a copy of the form from the QML Pathology
website. It is very important that you answer
all the questions on this form and then sign the
information acknowledgement section.
Example request form
9
Staying Safe While On Warfarin
WHAT TO DO WHEN BLEEDING OCCURS
For women: A heavier than normal menstrual cycle
lasting longer or showing large blood clots should
be discussed with your doctor.
Fresh or old blood in urine or in the bowel motion:
See your doctor first and then advise QML
Pathology Warfarin Care Clinic.
Minor bleeding from a cut: Most often can be
treated at home by applying firm pressure on the
cut for a longer length of time than normal using a
clean tissue or a wound dressing.
For lacerations/cuts requiring stitches: Wrap
the area with a firm bandage/ cloth, i.e., clean
tea towel or bath towel, maintain pressure on the
area, elevate if possible and go to your doctor or
nearest hospital.
Large Nosebleed: See your doctor or go to the
nearest hospital. Notify QML Pathology Warfarin
Care Clinic of the outcome.
Minor nosebleeds: These are quite common in
patients on warfarin, especially in winter. These
can be treated with pressure to the area, (high
up on the nose) whilst resting with the head
forward. A cold pack to the back of the neck
can help. Moistening the nasal tissues can help
prevent recurrence; try using a spray like Nozoil.
Once settled take care not to dislodge the clot by
blowing your nose!
Bleeding of the gums: Check with your dentist as
it may be gingivitis (inflammation of the gums).
If bleeding persists, please see your doctor. It is
recommended that you use a soft rather than hard
toothbrush.
Major bleeding is usually due to one of the
following:
• INR too high
• Taking other medicines which affect clotting,
e.g., aspirin
• Mucous ulceration or infection at the
bleeding site.
It is important to seek medical attention for
any major bleeding.
Important note: QML Pathology Warfarin Care
Clinic cannot advise on health matters unrelated
to warfarin. Please discuss these directly with your
doctor.
Other important factors
• The use of an electric shaver is recommended
for men.
• If you have a serious fall, or any significant
bump to your head you should see the doctor
and remind them you are on warfarin.
Pain: Any unusual pain that is severe or prolonged
and cannot be relieved by taking pain medicine
should be reported to your doctor.
Swelling: Any unusual swelling should be
reported to your doctor.
Pregnancy: Please notify your doctor
immediately if you think you could be pregnant.
Abnormalities to the baby can occur if warfarin is
taken in the early stages of pregnancy. Alternative
anticoagulation medicine is required at this time.
Warfarin can be taken after the baby is born and
during breastfeeding.
Warfarin
WHAT TO DO WHEN TRAVELLING
You must notify QML Pathology Warfarin Care
Clinic if you are going away on holidays or
business. Sometimes we can change your next
test date to fit in with your plans but other times
you will need a test whilst you are away.
If you are travelling:
• In Queensland and Tweed (Northern NSW):
Speak to QML Pathology Warfarin Care Clinic for
the address of a nearby collection centre and
give us a holiday contact number. A listing of
QML Pathology collection centres can be found
on our website qml.com.au.
• Interstate: Ask your doctor for a cumulative
report and letter outlining your medical
condition. Your QML Pathology request form is
not valid outside the QML Pathology network.
You will need to find a doctor at your holiday
location to do your test and give you a dose.
Your doctor may give you a dose over the phone
using the INR from your holiday location, if
you have pre-arranged this. On arriving home
contact QML Pathology Warfarin Care Clinic and
advise us of your current dose and suggested
test date.
• Overseas: Obtain a cumulative report and
letter from your doctor outlining your medical
condition and take ample supplies of your
medicine along with you. The medicine will
need to be taken in its original packaging
from the pharmacy with its prescription
labelling intact, i.e., do not put it in a dosette
box. This is for customs purposes. Your QML
Pathology request form is not valid outside
the QML Pathology network. You will need
to find a doctor at your holiday location and
work within that doctor’s system. On arriving
home contact QML Pathology Warfarin Care
Clinic and advise us of your current dose and
suggested test date. You should have travel
insurance, but be aware that many policies will
not cover pre-existing conditions.
INR is calculated in a way that allows results from
different laboratories to be compared. This means
that if you are tested by another laboratory while
on holiday, it will mean the same as if it were done
by QML Pathology.
Note: QML Pathology Warfarin Care Clinic
does not provide a dosing service when you
test outside the QML Pathology network.
11
WHAT TO DO WHEN UNDERGOING MEDICAL
PROCEDURES, SURGERY OR DENTAL WORK
• Tell the person doing the procedure that you
are on warfarin. The doctor/dentist doing the
procedure must tell you and QML Pathology
Warfarin Care Clinic how they want the INR
managed prior to the procedure.
• QML Pathology Warfarin Care Clinic will not
alter your dose until we know what is required.
If your doctor/dentist needs a lower INR for
the procedure this may take time to achieve so
adequate notice will be needed.
• Be aware you may need to miss doses in this
situation.
• People with mechanical heart valves should
not stop warfarin for more than a couple of
days unless covered by full dose heparin
injection (e.g. Clexane®) or as advised by their
cardiologist/cardiac surgeon. Any patient with
mechanical valves should discuss any cessation
of warfarin with both their cardiologist and QML
Pathology Warfarin Care Clinic.
• Contact QML Pathology Warfarin Care Clinic
and give details of the procedure and the
doctor’s name.
• The doctor doing the procedure should tell you
the dose of warfarin to recommence on and
advise when to have your next blood test. Please
inform QML Pathology Warfarin Care Clinic of
these details.
If you are admitted to or discharged from
hospital
• QML Pathology Warfarin Care Clinic cannot give you
your doses when you are in hospital. Your doctor will
do this for you whilst you are an inpatient.
• If a pre-booked procedure, notify QML Pathology
Warfarin Care Clinic two weeks before the procedure
is due so any dose changes can be made.
• If an emergency admission, please notify
QML Pathology Warfarin Care Clinic of your
admission, so we are not worried if you are not at
home for our collectors or not answering your phone.
• Please remind the hospital staff to notify
QML Pathology Warfarin Care Clinic when you leave
hospital, as we cannot recommence your dosing
until we get discharge information from the
hospital.
• If you are prescribed heparin injection (e.g.
clexane) when being discharged from hospital,
you will need to remain under the care of the
hospital or your doctor (unless under a private
specialist) until you have stopped taking heparin
and your INR results are in range.
Cardioversion procedure
If you are to have this procedure please notify
QML Pathology Warfarin Care Clinic as soon as
you have the date the procedure is to occur. Your
blood test results prior to this procedure will need to
be in range for at least a month before the doctor will
do the procedure. Therefore, you will need to have
weekly blood tests for a while, and sometimes the
INR range will change for this period.
• QML Pathology Warfarin Care Clinic is not
responsible for your warfarin monitoring when
you are in hospital or if you are taking heparin
(e.g clexane) injection.
• You will need to be reinstated in the Warfarin
Care Clinic after being discharged (short
stays may be exempt).
• Prior to discharge, ask the hospital staff to notify
QML Pathology Warfarin Care Clinic, as we
cannot recommence your dosing until we get
discharge information from the hospital.
• If your hospital admission is an emergency,
please notify QML Pathology Warfarin Care
Clinic as soon as possible. If it is a pre-booked
procedure please give two weeks’ notice.
Warfarin
ESSENTIAL WARFARIN INFORMATION
P
Make sure we can contact you at all times. If you have a mobile keep it switched on, or use a suitable answering
service for urgent messages.
P
Contact QML Pathology Warfarin Care Clinic within 2-3 days if you have not received your dosage instructions.
P
Continue on the same warfarin dosage until advised otherwise.
P
Take your warfarin at the same time each day
P
Remain on the same brand of warfarin.
P
Contact QML Pathology Warfarin Care Clinic when any medicine changes are for 3 days or longer. (Prescribed or over
the counter medicines, including antibiotics, pain relief, vitamins or herbal medicines, gels or creams).
P
Contact QML Pathology Warfarin Care Clinic if you are admitted to, or discharged from hospital.
P
Ask the discharging hospital for warfarin dose instructions before leaving.
P
Ask the discharging hospital to contact QML Pathology Warfarin Care Clinic to supply information of your admission.
We may not be able to immediately advise you of ongoing warfarin doses if we do not receive this information.
P
Tell us if you are taking heparin (e.g. Clexane®) injection. You must remain under the care of your hospital or doctor
(unless under a private specialist) until you have stopped taking heparin and your INR results have returned to range.
P
Contact QML Pathology Warfarin Care Clinic if you are to have any procedures, surgery, dental or otherwise, and
advise us of your pre-operative requirements.
P
Ask the doctor who is doing the procedure for post-operative instructions on when you should recommence your
warfarin and whether other anti-coagulant cover is required. Contact QML Pathology Warfarin Care Clinic and supply
this information so your next test can be planned.
P
Test on or as close to the date recommended by the Haematologist
P
Read the information in your patient pack.
O
Don’t use aspirin or aspirin based products unless ordered by QML Pathology Warfarin Care Clinic or your doctor.
O
Don’t use aspirin for pain relief. Aspirin is another form of blood thinner.
O
Don’t send QML Pathology Warfarin Care Clinic messages via SMS. This service is used only to supply you with your
INR, warfarin dose and next test information. We will not respond to SMS.
QML Pathology Warfarin Care Clinic:
Ph 1300 661 963 or warfarincare@qml.com.au
Mon-Fri: 10:00am to 3:00pm
Sat: 10:00am to 1:00pm
* Always provide your reference number with any communications. Have a pen and paper (or your notebook) ready to record your
results and/or dosage changes, or other information. If you are due to have a blood test, then write any new information on your
request form. Make sure one of the questions on your request form is marked with “Yes” so the changes will be forwarded to QML
Pathology Warfarin Care Clinic.
Do not send SMS.
What to do if you are told to stop taking your warfarin permanently
• Please notify the QML Pathology Warfarin Care Clinic as soon as you are advised to cease your warfarin.
• We need to know the name of the doctor who has advised you to cease warfarin so we can report this
information to your doctors and close your file.
Healius Pathology Pty Ltd (ABN 84 007 190 043) t/a QML Pathology PUB/MR/044_V18_Aug23_683059
qml.com.au