PROTIME MACHINE

Lisa Ritchey, RNSherrie Thomas, RN

Tracey McCaulley, RN

OBJECTIVES

• Define and describe trend• List and describe trend hardware and software• Identify, describe and review trend information system• Describe advantages/disadvantages of using trend• Examine legal and ethical issues related to use of trend• Describe technology-related competencies needed by the

professional nurse working with trend• Describe functions of the informatic nurse working with trend

TREND IN ANTICOAGULANT THERAPY MONITORING

Traditional

•Patient goes to lab

• Lab runs test; gets results

• Lab calls results to doctor

• Doctor adjusts coumadin dose

•Nurse informs patient of dosage change

New

• Patient runs test

• Patient gets results

• Patient adjusts coumadin

accordingly

Implementation of protime machine in home settings

WHY? In the new paradigm of patient-professional partnership patient self-management results in improved clinical outcomes with same quality of anticoagulation management.

GOAL:  Implement best practice in managing coumadin dosages in patients on long-term anticoagulant therapy by performing PT/INR testing in the home.

.(Beyth, 2005)

Hardware

ProtimeMachine

(ITC, 2006)

Cuvette Tenderlett Plus

Software

Coagutrax

• Built in alerts• Built in patient dosing tool• Source of documentation• Interfaces with the EMR• Automated charge entry

(Medmatics, 2005-2009)

Coagutrax

ADVANTAGES

cost effective

Speed of

results

convenient

Less invasive

DISADVANTAGE

S

dexterity

abilityRequired controls

Equipment cost

Cost Current Process Proposed Process

Mileage $10.80 $0

Travel time $30.72 $0

Increase staffing Costs

$49.00 $0

Cost of supplies $0 $5.00

(ITC, 2006)

Ethics Related To Home Monitoring Of PT/INR

• Responsibility shifts to the patient

•Patient’s are not skilled clinicians

•Impact on patient-professional relationship

(Martin, 1999)

Legal Issues

• Nurses competency• Corporate liability• Personal liability• Patient confidentiality

(Sullivan, 2005)

Technology-related competencies

Nurses must be proficient in:

• Use of hardware• Use of software• Conversion of data into information• Application of information into knowledge• Incorporation of knowledge into practice

(Sullivan, 2005)

Functions of the informatics nurse

• Critique the trend

• Evaluate hardware and software for usability

• Collect evidence to support best practice

(Sullivan, 2005)

Summary

• An example of new technology

• No delay in treatment

• Support for best practice

References

• Beyth, R. J. (2005). Patient Self-Management of Anticoagulation: An Idea Whose Time Has Come.

• ITC (2006). ProTime Machine Microcoagulation System.

• Martin, P.A. (1999). Bioethics and the whole: Pluralism, Consensus of the Transmutation of Bioethical Methods into Gold, Journal of Law,Medicine, and Etjics, 27 (4), 316-327.

References Cont.

• McGonigle, D. and Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Boston: Jones and Bartlet Publishers.

• Medmatics, LLC (2005-2009). Developers of Coagulax, Anticoagulation Management Software.

References Cont.

• Mendez-Jandula, B. M., Souto Juan Carlos, M.M., Oliver, A.M., Montserrat, M., Quimntana, M. R., Gich, I. M., et al. (2005). Comparing Self-Management of Oral Anticoagulant Therapy with Clinic Management. A Randomized Trial. Annals of Internal Medicine, pp. 142: 1-10.

References Cont.• ProTime PT-INR Testing Monitor-Process

Efficiency. (2008, January 31). Retrieved December 4, 2009, from Pro Time Test provided by QAS:http://www.protimetest.com

/homehealth efficiency.asp.• Sullivan, E.J. (2005). Effective Leadership

and Management in Nursing. Upper Saddle River, NJ: Pearson Education, Inc.