PT INR

[Willow Moonsidhe]

When do you all call the doctor on a PT INR level done in the home?

Thanks!

~Willow

[Willow Moonsidhe]

It was good with the doctor I got a hold of him today. We ended up 2 nurses short and they are hiring people as soon as interviewing if we can get some one in. We have had to go on no admits atm. We have two RN's FT and one PT. I went to do this lady's on Friday and the machine was broke so we had to get it fixed. We don't normally do them on weekends.

Thanks for all the replies.

~Willow

[LPN2000]

I have a Coag Check machine and immediately after I draw the PT/INR, I call my supervisor or the office and they fax the result to the MD with a request for a verbal order response.

[anticoagulationurse]

Under normal circumstances when I would get an INR of 2.2 I'd call to the MD during the visit like any other INR result.

On the weekend, it just depends if the order says "Call result to ___" or not. If the previous INR was also WNL I simply allow the patient to continue their same coumadin dose as previously directed (unless of course there is some special circumstance like upcoming surgery, or if 2.2 is NOT within their therapeutic range), and fax to MD so they get in Monday.

If the previous INR was wacky it is likely there has been some major coumadin dose changes in the last week/few days and to allow them to just continue on the current dose may not be appropriate. In this case I would call the MD on call for whomever ordered it and explain the situation, even if it is the weekend.

_________ (some info you didn't ask for)______________________________

The standard protocols for coumadin dosing are to add the daily dose to get a weekly total of coumadin and then divide by 7 and evenly distribute the mg using the fewest number of pills. eg, use a 5mg pill in different variations. Not a 3mg and a 4mg and a 6mg pill. For INR +/- 1.0 point, add or subtract 10-15% of the weekly dose and redistribute the daily dosing and divide by 7. If the INR fingerstick machine tests above 4.5 a venipuncture is procured to verify results.

[ProBeeRN, BSN, RN]

I like the INRatio machines that use the fingerstick, then I can call in the results from the home. For venipuncture-- if a routine and result is in line with previous results, I will usually call/fax MD in am to verify results recieved. If a stat/ results out of therapeutic range/ new on anticoagulation, then the on call gets called for orders.

[Lacie, BSN, RN]

We not only call the MD, but call the CLM who in turn also faxes the results on a standard sheet to the MD office. Not only will the RN get a verbal on the phone but we get faxed back the standard sheet with all pertinent info and order changes to include date of next draw. If weekend it still gets called to the oncall MD with verbal order written then faxed on Monday to the MD office for confirmation. we do this not only with critical/abnormals but for thoses wnl also.

[KateRN1]

We do it same as above.

[annaedRN, RN]

us too