The Coumadin Protocol

[CapeCodMermaid, RN]

COUMADIN ORDERS

Resident: __________________________________MD: _____________________________

Coumadin dose changes MUST be reviewed and signed by 2 (two) nurses.

Lab Draw INR algorithm

INR resultLa b frequency of INR draw

Change in Dose of Coumadin or new medication ordered with interaction2 x weekly on scheduled lab days

2.0--3.0 on two consecutive INR reportsChange to 1 x weekly on scheduled lab day

2.0--3.0 on four consecutive INR reportsChange INR to monthly on scheduled lab day

ANY CHANGE IN DOSE of Coumadin requires------Return to 2x weekly INR

Coumadin Dose Algorithm

INR resultCoumadin Dose

Less than 2.0INCREASE daily dose by 1 mg

2.0--3.0NO CHANGE in dose

Above 3.0HOLD Coumadin for one day and

DECREASE daily dose by 1 mg

Above 4.0HOLD Coumadin for two days and

DECREASE daily dose by 2 mg

Above 5.0HOLD Coumadin- call MD for further orders

THE ABOVE ORDERS FOR COUMADIN MAY BE USED

MD Signature_____________________________________________________

A new telephone order must be written for each INR.

hope this helps all y'all. ALL the ortho's around here use it

[KAW1962]

We also use a coumadin protocol on my ortho unit, although ours sounds a little less complicated. I don't remember it verbatim, but basically our patients get a loading dose of either 5mg or 7.5mg depending on sex, weight and age (women over age 65 get 5mg loading dose regardless of weight). We follow a chart that spells out the specific dose based on post-op day, INR and loading dose. Works out great for the majority of patients, although there are those whose INR jumps after one dose, so we need to be familiar with when to call the docs and get a verbal order. With these patients we can no longer use the protocol but instead have to get a daily order.

We also use protocols governing those patients who are on coumadin and lovenox. Usually the lovenox is discontinued when the INR is greater than 2.0.

Sometimes it does get confusing, especially when cardiology wants to manage the coumadin, but for the most part it works out very well.

[CapeCodMermaid, RN]

It looks more confusing than it is....and it's easier to follow in a table format but for some reason when I pasted it here, the table disappeared.

Basically...if INR

if it's 2-3 you keep the same dose...etc etc. The docs and staff liked it...far fewer phone calls...corporate hated it. "We DON'T allow protocols!!!"..puhleeze. Our medical director called the corporate medical director who actually LIKES the protocol. We still use it but now we call it something else. I'm trying (well, I was before I turned in my resignation) to get them to let us do our OWN INR's. More economic and if there is a problem you have hours to fix it....instant results.

[Aaron-RN]

On our Ortho/Neuro/Uro unit, our ortho patients recieving coumadin have daily INR's. Then we have a protocol where we take 1.5 and subtract from the INR. This gives us the coumadin dosage. For example if a pts INR is 1.2, they would recieve 3mg coumadin that evening. Hope this helps!