Any Anticoagulation Nurses out there????

Hey, I don't work in a Anticoag dept. but I do a lot of them in our family practice office. It must be kind of diff at times to figure out what to do with some patients. In the past our docs had a kind of standing order of what to do. But we had patients who either didn't understand or they would forget what we told them. So we gave them a card when we did their protime. That told them how to take their meds. It seemed to help compliance.

Hi~ I am not a Anticoagualtion Registered Nurse but interested in learning more about this position. Are you CACP certified? What training or prior work experience was required to obtain this position? Thanks for the info!

I work in a cardiology office. We have a *lot* of coumadin patients. Our clinical staff consists of two RNs and two very experienced MOAs; between us we share coumadin management responsibilities. The other RN or I must sign off on the MOAs' advice, but there is rarely if ever a problem with it.

I had zero coumadin clinic experience when I took the job two years ago; the senior RN mentored me and it took about 6 months until I reached a comfort level and didn't need her to cosign with me. We do finger stick INR's unless the value is way off (> 8.0); then we do a draw and check it through the lab. At that point we definitely get MD orders. The docs are also fine with us consulting them with unusual fluctuations, stopping therapy for surgery, or anything nonroutine that comes up.

Feel free to bounce any questions off me; I'll do my best

Hi my name is Angela and I am a coumadin clinic nurse in south Louisiana. I work for a cardiology group. I was hired to start the coumadin clinic, and I actually just started it this month.

So far I love what I do, but it would be nice to have others to chat with about certain things, so maybe we can exchange ideas and questions!

Have great day !

Angela, LPN
Coumadin Clinic Nurse

I am currently helping our company with different process improvements that invovle anticoagulation and tracking. One issue we have is with complaince of the standing orders. Any created thoughts on how the stading orders are processed?

I started working in anticoagulation 3 years ago. I was familiar with coumadin and INR's from working Internal Medicine back in 1997. This is a very niche area of nursing, and I it!

I managed a protime clinic for a large cardiovascular group here in Kansas City. When I started there I had very basic training and operated under a standard practice protocol. Basically, I would test the patient's INR via fingerstick with a CoaguChek machine (ROCHE), dosage adjustments, education, and rescheduling of their next appointment. I had 400 patients, 70% I saw in the clinic face-to face and the other 30% I managed via phone.

I did a tremendous amount of research in my spare time regarding drug to drug interactions, diet and other things that interfer with their INR not being in TTR (therapeutic target range). It was nice to work autonomously and create educational monthly topics. I even made a Vit K Game, with a drawing for a free Coumadin Cookbook (provided by the Bristol Myers Squibb-coumadin) every month. The patients loved it and it made learning fun.

I also organized a free patient seminar and had the Nurse Practioner and one of the EP doctor's present. This was a huge success with over 100 patients in attendance. Not only did the patients gain a wealth of knowledge, it was a way for the practice to enhance their EP dept procedures via education. The BMS rep brought a table full of "freebies" and so did the Sanafi-Avantis (Lovenox) rep. Nothing like get free everything!

I left the practice last November and now have my own company (Midwest Nursing Services) here in KC. I became a big supporter of PST (patient self testing) and started training for one of the 4 IDTF's. I now go into patient's homes and train them to test their own INR on the CoaguChek XS meter. Last year CMS expanded coverage of home testing to include Atrial Fib, DVT and PE. So, in other words anyone that is on long term anticoagulation can be covered if they are a suitable patient. Not only are the patients thrilled, it is very rewarding and profitable to boot.

I have researched the internet for a website that is specific to AC nursing and can not find one. So, I think I will take on the challenge and create one. There seems to be a growing need for the information and a network of nurses and healthcare providers in this niche of nursing and patient care. I would love to share stories and get input regarding difficult cases.

If anyone is interested in more information about training or getting patients, clinics or docs information on self testing I'd be happy to help.

Best wishes,
T

Hi,
I am a new grad FNP, about to take my certification test. All of my clinical rotations have been in primary care but I am interested in working with a specialty. I saw a position for an APRN at a Coumadin Clinic, and I wondered if you could tell me what that job would involve.

did you have NP's where you started?

They may want an NP with experience of some kind, even if not in Coumadin, but I am curious anyway.

Thanks a lot.

First Congrats!

Anticoagulation management is a niche area of nursing. When I started 3 years ago managing a PT Clinic for a large cardiovscular group, I knew very little about INR's and the challenges that patients face while on this medication. Since then I have self-educated....in otherwords I've surfed the net endlessly for as much information as possible.

Generally, the nurse in charge of the PT clinic will test the patient's blood via finger-stick to obtain an INR. Other patients have this done at an outside lab and the results are faxed into the clinic for management. You would assess the patient by asking them questions regarding bruising, bleeding, diet changes, medication changes, recent healthcare issues. You will adjust their Coumadin (warfarin sodium) usually, according to a set protocol, chart the visit/call, and reschedule their next visit or test. Patient education is very important. As with diabetic patients, those on coumadin need advice and guidance on diet (vitamin K), drug to drug interactions, and risk factors.

My newest passion has become PST or Patient Self Testing at home with their own meter. The company (IDTF-Independent Diagnostic Testing Facility) uses the CoaguChek XS meter. According to surveys this meter is used by 4 out 5 clinics as their POC (point of care) device of choice. Your management of these patients is basically the same as management of "phone patients" that go to outside labs for their INR and faxed results. PSTers test INR at home and call the result either to their clinic or the IDTF. If the IDTF is contacted they in turn fax the physician's office with the result. Critical values are always called in addtionally.

Your role will most likely involve new diagnosis of patients, initiation of anticoagulation therapy, monitoring and management. You will spend time discussing treatment options with these patients. These could include medication or procedures to treat the patient. I spend time consulting the cardiologists in the practice regarding INR regulation.

A good resource is www.anticoagultionforum.com as they have a national conference every other year. This year it was in San Diego and was fabulous. There were approximately 750 providers from across the US gather for this industry meeting. The next one will be in Boston in 2011.

I hope this has helped you undertand more about protime clinics. Obviously, the day to day management will vary clinic to clinic. I truly gained a passion for this niche of nursing and if you choose to folllow this path I think you will be very happy.

Good Luck,
T

PS You can reach me at tlipka@usnursenetwork.com if you have further needs!

Thanks for all the great info!
it does sound interesting.
I like the idea of being an expert at one thing, and with so many people on coumadin now, it would be a pretty good area to go into.
Seems like we all have to be self-taught, but that's how you really learn!