How would you have handled this?

[Happeetxn]

The other day I received a pt. from ICU who had an aortic valve replacement w/ a St. Jude mechanical valve (IIRC). Anyways, a family member who is an LPN (w/ 35 years practice under their belt, I passed boards in Feb 2007) is in the room when I come into give the pt their meds. One of the meds is coumadin. The pt asks "Do I have to take this?" to which I reply "Yes ****, it is necessary due to the mechanical valve that was used to replace your aortic valve, and its' properties help prevent clots from forming." The LPN family member could have drilled a hole in my head with the look that they gave me. They then proceeded to tell my pt. "The surgeon will re-evaluate your blood work in 6-8 weeks and we'll see what he says then." I chose not to have a battle over this topic right then and there. Later on I spoke with the surgeon who indeed said that the pt. would be on coumadin / warfarin for life and he would speak to them AGAIN!!! about this for the last time. What would y'all have done different. I assumed that the pt. was informed about this (coumadin) beforehand and the need for it. And, yes I do know what assuming does. Makes an A** out of U and ME. I thought I was just doing pt. teaching. Any and all comments appreciated as I have no desire to be a mediocre nurse, rather a thorough one who's pt's are well informed and cared for.

Craig

[TrudyRN]

You handled it well.

Reading your OP, I saw no problem. When you wrote about the rat poison in a later post, I then understood what the trouble was.

[Happeetxn]

I think you handled the situation almost perfectly. I agree with the nurse who mentioned the patient's right to refuse the medication. But otherwise, your comment was fine.

BTW, if you disagree with the doctor about the efficacy (but not the safety) of the prescribed treatment, don't bring it up with the family, that would be unprofessional. I have heard nurses tell the patient, "Oh, I don't know why the doctor ordered that for you. He's an idiot," and things to that effect. If you disagree with the doctor, there are always subtle ways to tell the family. For instance, "The doctor has ordered this for you. If you don't agree with it, you can always ask for a second opinion." It could be as simple as reminding them of their right to refuse.

I hope I would never do this (paragraph above)

If my pt. had refused the medication I would have explained to the pt. the potential risks of not taking it and then documented in the chart. I am not going to try to make anyone take something they don't want to. Had they refused the action I would have taken would have been to let my Charge know, probably wouldn't call the doc with this one, instead I would have left a note in the doctors charting section stating that that their pt. was refusing the coumadin. Our docs don't generally read our progress notes. Double charting but as a new one in the field I am big on covering my backside.

Again thanks for the input and information provided.

Craig

[jo272wv]

This is not uncommon, the lpn may have not been at the hospital when the Dr. spoke with the pt. You handled this correctly, the only thing different I may have done was to call the education dept and have them send up a pamplet on coumadin and valve replacement. I would have given one to the pt and another to the Lpn family member. Some people have to see it in writeing before they comprehend it.

Keep up the good work....

[SuesquatchRN, BSN, RN]

What else could you have done?

You done good.

[Noryn]

You did everything fine. Just because someone is a nurse or has years of experience doesnt mean they are experts in every field. I though always told most of my patients, no they didnt have to take the medication but if they didnt they could develop a blood clot which could lead to a stroke, pulmonary embolus, etc.

I hope I didnt freak too many of my patients out, because I told many of them Coumadin was rat poison. I told them the entire history though. Every now and then you will see some rat poison that still contains Warfarin but the pesky rats and mice have become more resistant to this so they have changed to another ingredient but it still an anticoagulant, just a longer acting one. Actually last I heard the vermin were becoming resistant to the newer ingredient as well.

Dont worry though, you are a newbie. As time goes by you will get more confidence.