Question about change in Coumadin dose

JKL33 · Feb 4, 2018

I was told that I should of assumed the Dr. Did not want any coumadin given that night.

Well that's kind of ridiculous. Why make a guessing game out of it rather than just writing, "Hold Coumadin tonight?" This is a very poorly written order for another reason: What if the RN present to receive the order wasn't the one who was to be passing medications that night? The order contains no indication that the evening nurse shouldn't give the med that is due. So, no, this was not right on the doctor's part.

If you want to get technical about it, this wording could cause another error - one in which both the 3 mg and the 2.5 mg are given the next night. Because the 3 mg was never officially stopped.

I would not accept discipline for this. I mean, they could suspend me for 3 days if they wanted to but my resignation would be forthcoming; in fact I would bring my 2-week notice letter with me on Monday just in case. Just on principle. People treat you the way you allow them to.

Be calm and professional on Monday and see if you can make your case about the way in which the order was written and how that could've led to at least a couple of errors other than the one you (supposedly) made. If you are asked to comment or sign anything for your personnel file I would write that you gave an ordered medication as ordered.

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That said - any order that could possibly have more than one meaning should be clarified, and that is your duty - both to recognize it and to follow through with the phone call. If you aren't 100% confident about what the physician wants you to do with a Coumadin order, you must call.

MilliePieRN · Feb 4, 2018

Do you not have access to inr levels before giving it? I never give Coumadin without knowing inr... if the inr was too high, you'd be responsible for questioning the order to give it "tonight".

Vitamin k isn't given with all high inr levels, that should not factor into your equation.

MunoRN, RN · Feb 5, 2018

If I were you I would keep it professional (I say this because if I were me there would be a long string of expletives directed at whomever considers this to be an error worthy of punishment), but simply point out what was communicated to you, which is that the 3mg dose was not held or discontinued, which means it is still active, and that the dose would change to 2.5mg on Monday. I would help educate them and the MD that if he wants the 3mg dose held for that night, he needs to write "discontinue 3mg Coumadin q daily" or "hold 3mg Coumadin dose on ..day". I would also probably remind them how to write these things, you take a pen or other writing instrument that leaves some sort of residual markings on a piece of paper, rock, watermelon, whatever will retain these markings long enough for you to see them and therefore understand what it is you are expected to do (again, you might leave that part out).

I would be sure to point out that avoiding medications is dependent on clear communication, and ask if they really believe that assumption based non-communication qualifies as 'clear communication'.

offlabel · Feb 5, 2018

Ahhh...punishing "errors"....and people wonder why nursing is in the state it is and why advanced practice is such draw for people that possess the chops to leave the bedside. Carry on...

Irish_Mist, BSN, RN · Feb 6, 2018

Ahhh...punishing "errors"....and people wonder why nursing is in the state it is and why advanced practice is such draw for people that possess the chops to leave the bedside. Carry on...

Exactly. This mindset of punishing med errors has actually been proven to be detrimental to patient safety because nurses are more likely to lie about making mistakes or cover them up due to fear of punishment or loss of job.