PT/INR Orders WHO can WRITE?

[GJohn]

Greetings! I am an administrator of a home health agency and involved in an interesting discussion, and I could use your advice!

If you receive orders from a physician to perform PT/INR's in home on your patient and report the results back to the PT/INR clinic 1w6. Each week you fax the results into the PT/INR clinic and based on the physician that has already seen the patient and determined the patients Coumadin dosage vs his/her PT/INR levels, the nurse who works for the physician sends you an order back to adjust the med. Do I need to send all of the orders that I have accepted back for signature, before I get an audit or my JC inspection? Or is there anything out there that can "save" me from all of that work?

Do you accept the order and carry out the med change?

If yes, is there any documentation to back it up?

[anticoagulationurse]

I don't think I can be much help from an administrative perspective but I have worked both as the nurse sending the orders to HH from the protime clinic and also as the HH RN reporting the result to the protime clinic.

As a HH nurse, when I receive orders I chart in the appropriate place in the lab results/med order place and call the patient with the result. I do NOT change the master med list on the med orders each time the dose changes, as this would be an incredibly ridiculous waste of time when Coumadin doses change so much.

On the other side, when I was sending med refills on behalf of the MD while working for the protime clinic I would NOT put the daily dosage on the bottle as there were several incidences of people not remembering their instructed dose changes and then consulting the bottle which pertained to an old dose regimen and hence taking the wrong dose. Therefore I always sent the sig as 1 po daily AS DIRECTED ("consult protime clinic at 555-1212 for dose instructions"). The same idea relates to the med list for HH. The med list has the dosage available to the patient but for individual doses for a given time, appropriate charting is related to the INR result not to the master list.

Not sure that really addresses your question fully!

[kids]

Greetings! I am an administrator of a home health agency and involved in an interesting discussion, and I could use your advice!

If you receive orders from a physician to perform PT/INR's in home on your patient and report the results back to the PT/INR clinic 1w6.Each week you fax the results into the PT/INR clinic and based on the physician that has already seen the patient and determined the patients Coumadin dosage vs his/her PT/INR levels, the nurse who works for the physician sends you an order back to adjust the med. Do I need to send all of the orders that I have accepted back for signature, before I get an audit or my JC inspection? Or is there anything out there that can "save" me from all of that work?

Do you accept the order and carry out the med change?

If yes, is there any documentation to back it up?

In the areas I work we do not need to get orders coming from the Coag clinic re-signed by the Doc.

The Docs who pass off their patients to the Coag clinic don't have anything to do with their Coumadin after that, dose adjustments are made using standing orders and protocols and the 'order' that is faxed to the agency/facility reflects that. It's not been an issue during State or Federal audits/surveys at any of the facilities or HH agencies I've worked at in WA or OR.

I'd contact the coag clinic you're dealing with (not the Doc) and ask them. They very likely have a form letter they can send you that covers it.

[berube]

we use a pt/inr report form,,,results with current dose are faxed to MD, the MD office returns it with the bottom portion of the form filled out with dose change or "same dose" and the next lab, if it is not signed by the MD we have to write a verbal order and send that. alot of times it is signed by the NP or PA and we need to write a verbal order and get it signed by the MD.