A little background first, I am a new grad, still on orientation and the other day I had a MD write an order that just didn't seem right. I asked some of my colleagues, and they all seemed to be ok with it, but I wanted to get some more input.
So I was taking care of a pt admitted for ALOC, dehydration and weakness. The pt's history was advanced AIDS, MI x2, pacer, BPH, and atrial thrombus. When this pt was admitted the INR was 6.7, he was on coumadin at home but obviously it was not to be continued while admitted.
Fast forward to the next day, when I was getting report on him, his INR is now 7.7. The off going nurse and I catch the MD and bring up the high INR to him, and his response was basically: "well, I'm not going to do anything about it, because he has an atrial thrombus, so I don't want to clot him up any more".
The MD proceeded to write an order that stated:
Don't call unless the INR is >10 or the pt is actively bleeding
Our policy is to call the MD for any critical lab values, and an INR gets to be critical way before it reaches 10. This order just seemed to be weird to me, it almost seemed like I was just waiting for him to bleed out before the MD wanted to address the situation.
I would love some input from you all, as I am just in the process of learning what/when to question and/or stand up to improper orders.