Get the free Dabigatran Initiation Proforma - mmwirralnhsuk - mm wirral nhs

Dabigatran Initiation Proforma To be completed by the prescriber authorizing initiation, as part of the decision-making process, and kept in the patients notes Patient details Name: DOB Practice Number:

How to fill out dabigatran initiation proforma

How to fill out dabigatran initiation proforma:

1. Start by entering the patient's personal information, including their name, date of birth, and contact details.
2. Next, record the patient's medical history, including any relevant past illnesses, surgeries, or medications they are currently taking.
3. Then, document the reason for initiating dabigatran therapy. This could include a diagnosis of atrial fibrillation, deep vein thrombosis, or pulmonary embolism, among others.
4. Indicate the dose of dabigatran recommended for the patient, based on their specific condition and risk factors. This may vary between 150 mg twice daily or 110 mg twice daily.
5. Specify the date when the initiation of dabigatran is planned or has already occurred.
6. Include any relevant laboratory test results, such as renal function tests, liver function tests, and complete blood count, as these may influence the dosing and monitoring of dabigatran.
7. Provide any additional comments or instructions regarding the use of dabigatran, such as precautions to take, potential adverse effects, or drug interactions to be aware of.

Who needs dabigatran initiation proforma:

1. Patients with atrial fibrillation who require anticoagulation therapy to reduce the risk of stroke and systemic embolism.
2. Individuals who have experienced a deep vein thrombosis or pulmonary embolism and need anticoagulation to prevent further blood clots.
3. Certain patients with mechanical heart valves may also require dabigatran therapy, depending on the type of valve and other individual factors.
4. The dabigatran initiation proforma is primarily used by healthcare professionals, such as physicians or pharmacists, to ensure standardized and accurate documentation of patient information and treatment plans.

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What is dabigatran initiation proforma?

Dabigatran initiation proforma is a form that needs to be filled out when initiating treatment with the medication dabigatran.

Who is required to file dabigatran initiation proforma?

Patients who are starting treatment with dabigatran are required to file the initiation proforma.

How to fill out dabigatran initiation proforma?

The dabigatran initiation proforma can be filled out by providing all the necessary information about the patient and the prescribed treatment.

What is the purpose of dabigatran initiation proforma?

The purpose of the dabigatran initiation proforma is to track the initiation of treatment with dabigatran and ensure proper monitoring of the patient.

What information must be reported on dabigatran initiation proforma?

The dabigatran initiation proforma must include details such as patient's name, dose of dabigatran prescribed, start date of treatment, and doctor's information.