Self-Management Teaching Plan
May 1, 1999
Self-Management Teaching Plan
Training consisted of three consecutive weekly sessions (60-90 minutes each) for a group of 3-6 patients.
Session One
• Discuss general anticoagulation information.
• Teach self-monitoring using whole blood prothrombin time/international normalized ratio (PT/INR) monitor.
• Encourage subjects to measure INR values routinely during first week and to record INR results and anticoagulant dosage in logbook.
• Check subjects’ quality of INR value self- monitoring at session end.
Session Two
• Check subjects’ quality of INR self-monitoring at beginning of session.
• Discuss prevention of bleeding and thromboembolic complications.
• Discuss effect of diet on anticoagulation control.
• Discuss effect of additional medication on anticoagulation control.
• Provide instructions about indications for changing anticoagulation medication and protocols for reducing or increasing anticoagulation medication to achieve desired INR targets.
• Explain and monitor practice exercises completed by subjects.
Session Three
• Check subjects’ quality of INR self-monitoring at beginning of session.
• Reinforce instructions about indications and protocols for reducing/increasing anticoagulation medication to achieve desired INR targets.
• Discuss examples of adapting drug dosage and practice exercises completed by subjects.
• Discuss possible problems resulting from surgery, illness, exercise, pregnancy, and travel.
• Encourage subjects to control INR values by self-monitoring 1-2 times per week and to adjust the anticoagulation medication dose accordingly.
• Remind subjects to contact the teaching center if they encounter problems.
After completing the program, participants were expected to estimate their INR value with a deviation of less than 0.4 from the reference INR measurement. If they could not, the training program was repeated.
Source: Sawicki PT, for the Working Group for the Study of Patient Self-Management of Oral Anticoagu lation. A structured teaching and self-management program for patients receiving oral anticoagulation. JAMA 1999;281:146.