Priorities and delegation

[Lazy Nite]

Take it easy Jon

Its only practice for fellow forum members…..

It’s an important skill to have

[Rafael]

'The warfarin clinic has called you because one of the patients INR has come back high and wants you to amend the dose.'

do you mind to explain how would you go on modifying the dose? which reference do you follow? or is it different from 1 hospital to another?

[Lazy Nite]

Hey Raoul

Patients started on warfarin will be given a supply of 1mg, 3mg and 5mg tablets to make dose adjustments easier. Depending on the indication, patients will have an INR target……so if the anticoagulant clinic gets a high or low INR….adjustments should be made.

Some hospitals have an anticoagulant pharmacist….they can easily make the adjustments.

Know your counselling for warfarin...

[Rafael]

thanks lazy. i am aware of that but i am looking more into how to relate changes in INR to dose adjustment.
a real life scenario would be appreciated.
i.e assuming someone with an INR of 4-5, and we need to target 1.5-1, he was on 5mg warfarin, how would you adjust the dose?
Cheers lazy

[johnep]

There is software available to control the whole clinic. Dawn is a leading brand. CPPE holding series of anticoagulation meetings next year, I am going to one in Cambs.
johnep

[Lazy Nite]

‘INR of 4-5, and we need to target 1.5-1, he was on 5mg warfarin, how would you adjust the dose?’

They may initially stop the warfarin to lower the INR, and then re-introduce it at a lower dose such as 3-4mg alongside monitoring the INR.

Here is an excellent link for managing anticoagulants:

Actions that can make anticoagulant therapy safer

I’m going to the CPPE workshop too…in London though. I went to ‘Asthma’ focal point, found it very useful and good for networking.

[Pharmanaut]

That posting is definitely one to stress-test a pharmacists capabilities.
Even though it is an training scenario I feel stressed and may not sleep tonight trying to work it out. Thanks!

[Lazy Nite]

Hahahaha….ur so funny!

I’ve got plenty more scenarios to keep you going if you’re interested…catch up on your beauty sleep first!

So what’s your answer?

[Jeff]

The warfarin clinic has called you because one of the patients INR has come back high and wants you to amend the dose.

Tell the warfarin clinic to contact the patient and amend the dose instructions themselves. If they want to delegate that - then to put it in writing - so that there is a written audit trail.

Jeff

[lamzee]

One of the hospitals near here has stopped discharging patients with 3mg and 5mg warfarin altogether. Patients are instructed to only use 1mg tablets, and some of the GPs have got the hang of it so far.

Too many old folk getting the colours mixed up.