Coumadin protocol

[CapeCodMermaid, RN]

Do any of you use a Coumadin protocol? I used one at one facility but when I mention it I'm told it's not possible. Am I living in a dream world? I've used one...orthos liked it, docs liked it, much easier for everyone.

[Ruas61, BSN, RN]

Most of ours are done through a Coumadin clinic or by the individual doc.

[nurseferatu1]

The Doc gives us his protocol, definately individual Md choice.

[whatdidigetmyselfin2]

We have a coumadin protocol at my facility. Depending on the pts INRs, we have certain standing orders for what we should give and when we need to call our MD.

[Havin' A Party!, ASN, RN]

FWIW, I've worked with several docs that insist on being contacted, and won't agree to use a protocol.

[Sam J.]

Couple years ago a place I was at had one- an INR range was specified on the MAR, for each DX for the Coumadin. Every physician in that place signed off on the same ranges, for the same DXs. Sounds simple, and you'd think it'd save countless phone calls. Only problem is that less than half of the labs were ever drawn, as ordered, so Coumadin was often given based on an old INR, that was also posted in the MAR. All but one doc opted out- that last one preferred to be called with repeated med error reports, rather than be called with constant lab reports, because he said wasn't his problem if the labs weren't drawn, he had already signed standing orders that 'ought to have been followed'. Nightmarish.

[NurseGuyBri]

We use coagucheck machines and the docs review every single one individually. The only difference for us from most other facilities is that if the doc doesn't respond by the time the dose is due, it is automatically held.

[Sam J.]

We use coagucheck machines and the docs review every single one individually. The only difference for us from most other facilities is that if the doc doesn't respond by the time the dose is due, it is automatically held.

Interesting. I'm curious who paid for or leases the machine(s), and if or how they charge for the tests. Also, if there has been any concern over the accuracy of the INRs, is there a backup protocol to involve the lab? If this is new for your place, has it cut down on med errors regarding Coumadin? If it's accurate, and reduces med errors and time and expense, seems like a bang-up idea.

[CapeCodMermaid, RN]

I used the machines in one building. The company gave us the machine for free, but the strips were expensive. The cost worked out in our favor, however, because the lab wouldn't draw INRs on the weekend unless they were STAT and that was a huge expense.

We had quite a few ortho patients and it seemed the docs always wanted the INRs on a Saturday or Sunday when the lab wouldn't come, so I loved using the machine. Learning curve very low. If you can use a glucometer you can use the coag machine.

We had to prove we were getting accurate results when we first started using the machine by comparing our results with 40 same day lab draws. It was a cumbersome process but certainly worth it in the end.

All the VNAs use the coag machine. It's much easier than a blood draw. We don't use them at my current facility since we pay a flat rate to the lab and they come out every day to draw any tests we need.

There might be a way to bill it out under Med B but I never looked into that.

[BBRANRN2013, ASN, RN]

One of our MD we fax the Inr and the other md we have a protocol for

[noc4senuf]

Most buildings I have been in for the past 10 yrs or so have INR machines. We billed Medicare for the cost of the draw and strips. Faster than waiting for a lab.

[NutmeggeRN, BSN]

We use the lab for the weekly/monthly draw. There are standing orders (based on INR) for most, not all, residents based on their dx. The coumadin flow sheet is in the front of the MAR with the lab day having INR written in where it is supposed to be signed when given. That way meds are not given without a current order. If the INR is missed/not drawn, a TO is obtained by provider on call to continue with prev orders until the result is in.