Coumadin

Sun0408, ASN, RN · Jul 10, 2013

An INR of 3 or greater will get a call to the MD.. If the MD wants a higher INR, maybe they should state that in their order.

loriangel14, RN · Jul 10, 2013

We get our orders every day on the INRs that were done that morning. Some MDs have different goals for the INR and will give different orders for the same numbers.

MunoRN, RN · Jul 10, 2013

Goal ranges vary mainly based on the purpose of anticoagulation for that particular patient, as well as their history. Typically, the goal is 2.0 to 3.0, although for many purposes it is 2.5 to 3.5, for some patient who haven't tolerated a therapeutic level they may have a goal range of 1.5 to 2.5 with a goal of 2.5. Here's a good reference for the varying goal ranges.

Whether to hold or not, and dose adjustments have been handled my Pharmacy everywhere that I have worked.

nurseprnRN, BSN, RN · Jul 11, 2013

It may aso depend on the physicians' assessments of exactly why these people need to be on warfarin. Why not ask them?

TBlase · Jul 12, 2013

Based on the scale and directives ordered along with the Coumadin dose, to prevent constant phone calls to and fro: "For INR from 1.00-2.00 give ___ MG of Coumadin","For INR 2.01-3.5give ___ MG of Coumadin", and so forth. Or, "Hold Coumadin for INR over:___". Or, "Call for INR over: ___". Like the typical blood sugar/insulin chaos. Some places even have standing orders for insulin and Coumadin, to include lab draws, and those really cut a lot of headaches from a med pass!

psu_213, BSN, RN · Jul 12, 2013

On a telemetry unit, where we gave a lot of warfarin, we had to document the INR on the MAR with each dose (we also had to have a witness cosign that we were giving the ordered dose, which was the stupidest cosign ever, IMHO!). I forget what the exact written policy was, however if the dose seemed inappropriate for the INR (or if giving the med at all was inappropriate), then a call to the doc was in order.

Sometimes, the person's PCP would write a coumadin order and cardiology would come in later a write for a different dose...for instance, cardiology wanted them "more" anticoagulated so they wrote for a higher dose. In that case, the latter order would be the one to go with. If there was any question in my mind about which does to go with, I would call the doc.

Coumadin management is not rocket science (and a lot less complicated than insulin dosing). However, if there are any questions, always call the doc and get a clarification.

2bTraumaRN2008 · Jul 19, 2013

Our pharmacist's dose our coumadin, and with that we have parameters telling us when to hold. We also have to document our INR when we do administer.

mama2 · Jul 20, 2013

We use a standard protocol for 5-10% increases or deductions depending on INR and therapeutic range. INR 5 or greater will warrant an MD notification (when 2- 3 is the range). If the range is 2-3 and the patient's INR is in the 4's, I will hold one dose or consider a 10% reduction in dose.

mlbluvr · Jul 22, 2013

We use a standard protocol for 5-10% increases or deductions depending on INR and therapeutic range. INR 5 or greater will warrant an MD notification (when 2- 3 is the range). If the range is 2-3 and the patient's INR is in the 4's, I will hold one dose or consider a 10% reduction in dose.

Ok, then- a clear reason to have the use of 'warfarin' OUTLAWED. Not only is this reply enough to give anyone a migraine headache- just imagine having 10 or 15 patients on 'warfarin', with the constantly changing lab values, and orders, and chances for med errors. Not only does warfarin have more side effects than benefits- it's also considered one of the most unstable of medications that have ever been allowed to be made under generic trademark laws- every manufacturer (and the cheaper the better?)has different efficacy levels, contents, stability, etc. Outrageous. If ever a med has proven not to be safe and effective as a generic, this proves the case.

DesertRN2009 · Aug 1, 2013

Depends on why they are on coumadin and the goal range. Also if they have lovenox or heparin as well. Plus some antibiotics lessen the effect

mama2 · Aug 5, 2013

obviously there is more to our protocol than I can write about here, but we have a very good success rate with keeping patients within their prescribed therapeutic range. A lot of patient teaching is done, and continuous monitoring. I think it's more of a headache when the RN's have to constantly ask the MD's what to do for every little INR change. If the patient is ambulatory, and cognizant, has been stable for X amount of time on a certain dose and has suddenly been eating a lot of cabbage/greens, and comes in w/ an INR of 1.8 I know I don't really need to freak out or ask an MD what to do. What works for one setting/patient doesn't work for all- but it helps when everyone is performing at the top of their licenses and can utilize critical thinking skills.