low-literacy med handout for coumadin

  1. I have a home health patient whose literacy level probably does not go much beyond the 4th or 5th grade level. She had been on Coumadin after an MVI but discontinued without telling anyone and promptly ended up with a PE and another 4 days in the hospital. I've been charged with the task of explaining to her why compliance is necessary (although the PE may have done that job already). I'm fairly confident of my teaching abilities, but haven't been able to find a teaching sheet for coumadin that is quite at her level. I'm looking for something that is one page, no big words, and pretty direct with the possible consequences and the side effects to watch out for. Is there something like that out there or should I just buckle down and make one myself?
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    About KateRN1

    Joined: Jun '05; Posts: 1,203; Likes: 1,038
    Home Health; from TR
    Specialty: 20 year(s) of experience in COS-C, Risk Management

    9 Comments

  3. by   Nurse523
    It wouldn't hurt to make one. Who knows maybe you would need it in the future and other nurses in your unit can use it too and give you credit on the handout.
  4. by   misswoosie
    Quote from KateRN1
    I have a home health patient whose literacy level probably does not go much beyond the 4th or 5th grade level. She had been on Coumadin after an MVI but discontinued without telling anyone and promptly ended up with a PE and another 4 days in the hospital. I've been charged with the task of explaining to her why compliance is necessary (although the PE may have done that job already). I'm fairly confident of my teaching abilities, but haven't been able to find a teaching sheet for coumadin that is quite at her level. I'm looking for something that is one page, no big words, and pretty direct with the possible consequences and the side effects to watch out for. Is there something like that out there or should I just buckle down and make one myself?
    I think that the BIG question would be whether she is a suitable candidate for coumadin.

    I would also want to know
    1. Does she concord with her other med regimes?
    2. What is her reason for stopping the coumadin?
    3. What support does she have at home? ie is there someone who can supervise her taking meds
    4. Does she drink alcohol-if so how much and how regularly?
    5. Is her diet balanced?
    6. How long was she on coumadin?
    7. Was her INR ever in therapeutic range?
    8. How often was her INR being monitored and by whom?


    Some people just aren't suitable candidates because coumadin is such a high risk drug.
  5. by   misswoosie
    Sorry- I wanted to ask what an MVI was?
    Mitral Valve .......... ?
  6. by   KateRN1
    Quote from misswoosie
    I think that the BIG question would be whether she is a suitable candidate for coumadin.

    I would also want to know
    1. Does she concord with her other med regimes?
    2. What is her reason for stopping the coumadin?
    3. What support does she have at home? ie is there someone who can supervise her taking meds
    4. Does she drink alcohol-if so how much and how regularly?
    5. Is her diet balanced?
    6. How long was she on coumadin?
    7. Was her INR ever in therapeutic range?
    8. How often was her INR being monitored and by whom?


    Some people just aren't suitable candidates because coumadin is such a high risk drug.
    Yes, she was a suitable candidate in all other ways. She stopped the coumadin because she saw an ambulance-chaser ad on TV and was scared that something might happen to her. She's in her early 50s, has minimal support at home, but everything else is no problem. Just not the sharpest tool in the shed.

    MVI = Motor Vehicle Incident
  7. by   misswoosie
    Quote from KateRN1
    Yes, she was a suitable candidate in all other ways. She stopped the coumadin because she saw an ambulance-chaser ad on TV and was scared that something might happen to her. She's in her early 50s, has minimal support at home, but everything else is no problem. Just not the sharpest tool in the shed.

    MVI = Motor Vehicle Incident
    errr-what's an ambulance chaser ad?
  8. by   KateRN1
    Quote from misswoosie
    errr-what's an ambulance chaser ad?
    Watch TV for an hour, you're bound to see one. It goes something like this:

    Picture of pills and bottles in slow-mo moving down the screen.

    Voiceover: Have you or someone you love taken Coumadin and suffered a stroke?

    If so, you may be eligible for a cash reward.

    What your doctor doesn't tell you can hurt you.

    Cut to picture of smartly-dressed-attorney-type who says something like: "Millions of patients suffer strokes after taking the dangerous blood-thinning drug, Coumadin. If this has happened to you or someone you love, you deserve to be compensated. Call our hotline right now to have your case evaluated."

    Cut to picture of balance scales of justice with an overlay of the impressive name of the law firm in huge bold type along with the phone number of the hotline. But don't notice the teeny tiny print at the bottom of the page that says something to the effect that not all cases qualify and stroke is a known risk factor for coumadin administration.

    The same ads come out anytime the FDA takes a new position on a drug. They were there for Fen-Phen, for Vioxx, and others I can't think of at the moment. I'm sure we'll see some ads for Tylenol soon.
  9. by   rph3664
    Quote from KateRN1
    I have a home health patient whose literacy level probably does not go much beyond the 4th or 5th grade level. She had been on Coumadin after an MVI but discontinued without telling anyone and promptly ended up with a PE and another 4 days in the hospital. I've been charged with the task of explaining to her why compliance is necessary (although the PE may have done that job already). I'm fairly confident of my teaching abilities, but haven't been able to find a teaching sheet for coumadin that is quite at her level. I'm looking for something that is one page, no big words, and pretty direct with the possible consequences and the side effects to watch out for. Is there something like that out there or should I just buckle down and make one myself?
    Call the pharmacy. We get requests for things like this all the time.

    (this is assuming it's open)
  10. by   misswoosie
    Quote from katern1
    watch tv for an hour, you're bound to see one. it goes something like this:

    picture of pills and bottles in slow-mo moving down the screen.

    voiceover: have you or someone you love taken coumadin and suffered a stroke?

    if so, you may be eligible for a cash reward.

    what your doctor doesn't tell you can hurt you.

    cut to picture of smartly-dressed-attorney-type who says something like: "millions of patients suffer strokes after taking the dangerous blood-thinning drug, coumadin. if this has happened to you or someone you love, you deserve to be compensated. call our hotline right now to have your case evaluated."

    cut to picture of balance scales of justice with an overlay of the impressive name of the law firm in huge bold type along with the phone number of the hotline. but don't notice the teeny tiny print at the bottom of the page that says something to the effect that not all cases qualify and stroke is a known risk factor for coumadin administration.

    the same ads come out anytime the fda takes a new position on a drug. they were there for fen-phen, for vioxx, and others i can't think of at the moment. i'm sure we'll see some ads for tylenol soon.
    omg- we don't get those in the uk and have to admit that i haven't seen them in the us.
    we only get ones saying "had an injury at work" or "injured in a car accident that wasn't your fault" then "we can help"

    i still think that maybe she hasn't got the intellect to work out that it is better for her to keep taking her coumadin and may be better off on treatment dose lmwh injections given by a nurse, but i understand cost implications over there.

    i have given some links to info for warfarin used in the uk -you can see how modifiable they are

    http://www.royalfree.nhs.uk/pip_admi...gulant_141.pdf
    http://www.doctorwigg.co.uk/pdfs/warfrin.pdf
    http://www.cks.library.nhs.uk/patien...lants_warfarin

    http://www.bch.org.uk/acrobat/pdf%20...0treatment.pdf

    the one in red might be most useful. i was looking for info for kids,but all seem to be for parents about their kids warfarin!
  11. by   MAISY, RN-ER
    I was recently researching a paper and the advice for those with low literacy was a 3rd grade level. Large font, only a few words in a sentence, space between sentences, pictures, and TIME!

    Patient education is critical with this type of medication and improper instruction does lead to lawsuits; especially if ability to learn is noted in the chart!

    Good luck
    M

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