[flalpn]

Hello everyone. This is a situation that passed but still I am curious about. I am new grad so please excuse me if this sounds simple. I had a pt that was on 9mg coumadin and her INR was 4.2, The doctor than increased her to 11mg coumadin. This was not seeming right as I was taught that the more coumadin the higher the INR which the norm for is 2-3. I asked numorous people at the fac and I don't know if they didn't understand my question or what but they said the higher the dosage the lower the INR. Can someone please tell me which is true. I am almost sure that the higher the dosage the higher the INR. Anyway another INR was done 2 days later that was 5.4 and imagine thgey held the coumadin for 5 days. Please let me know what you think as my gut told me I was right and I like having that instinct(especially when its right)

[RNinSoCal]

Hello,
There are 2 possibilities that I can think of. One is that the MD did not read the lab results or read them incorrectly before ordering the higher dose. It does happen. Another possibility is that the pt has a diagnosis or needs a procedure that requires a higher INR than usual. Even then an INR higher than 4 usually requires a lower dose of Coumadin. I am thinking the MD made a mistake. Maybe someone else has another idea.
I always clarify orders if they seem out of the norm. Most MDs are grateful when their mistakes are caught before thay are carried out. Some do get grumpy and say "why are you bothering me about this". I just say "I was worried about (fill in the blank with adverse effect) and wanted to make sure this is what you wanted". After all, the pt is paying me to worry about these things and ask questions.

[RGN1]

I always risk "the wrath of doc" if I'm not sure/happy about an order. In the long run it's actually ended up earning me more respect in the places I've worked so far.

Ok it helps that I play the dumb blonde sometimes but hey........ whatever works !!

Seriously though - if you're not sure - check it out. The worst that can happen has still got to be better than the potental harm a wrong order might do!

[traumaRUs]

You are right - the higher the Coumadin dose (usually), the higher the INR. For orders that you are concerned with, please question the order. It is better to question it versus being part of a med error with potential harm to the patient.

The excuse "I was only following the orders" won't stand up in court.

[flalpn]

Thank You all very much!!!! As a matter of fact I was right in trusting my intuition and will do so from now on. The doc came back when the next INR was 5.7 and held coumadin for 5 days . He then put her on 6mg and the next INR was 1.17 now he is taking her up slowly. But I will definitely ? him next time as I have taken many orders in which the MDs order things that haven't worked before so I am sure they have forgotten if they even really remember the pt you are talking about. I have no problem doing what is best for the pt in the longrun. Thanks again