Open Forum

 View Only

  • 1.  Coumadin Clinic Patient Non-Compliance

    Posted 09-13-2022 16:23
    Hello, 
    I am curious for those that have nurse-run Coumadin Clinics, do you have a process you can share on how your nurses manage patient non-compliance such as not adhering to testing.

    Do the patients get dismissed?
    Do you have a patient agreement "contract" they sign acknowledging their responsibilities and grounds for dismissal? 

    If you could share what you may have, I would appreciate that.

    ------------------------------
    Heather Moretti, MSN, NE-BC, RN
    Manager, Nurse Triage & Coumadin Clinic
    Edward-Elmhurst Medical Group
    Elmhurst IL 60126
    Ph: 331-221-9780
    ------------------------------


  • 2.  RE: Coumadin Clinic Patient Non-Compliance

    Posted 09-14-2022 09:39
    Hi Heather;
    Best practices for anticoagulation clinic protocols include a patient education visit to inform the patient of risks/benefits and responsibilities. The patient signs and dates that agreement, and it is revisited and updated annually. Language includes acknowledgment on the patient's part that they risk their health if they do not follow the prescribed regimen of testing, medicine adjustment etc.
    It is up to the prescriber to determine if coumadin can still be safely prescribed for the patient who does not adhere to the regimen, and up to the anticoagulation clinic nurse to contact the prescriber to report that finding.

    ------------------------------
    Leslie McDowell ANP-BC, DNP, RN
    QI Specialist / Curriculum Developer
    Northwest AHEC / Wake Forest University School of Medicine
    Winston Salem NC
    (336)972-7852
    ANP-BC, DNP, RN
    ------------------------------

    Original Message


  • 3.  RE: Coumadin Clinic Patient Non-Compliance

    Posted 09-14-2022 11:27
    Hi Heather,
    Similar to what Leslie shared, our organization relies on nursing's communication with the patient and the provider when these situations arise, since there are always nuances to consider. We do use a patient contract at the time of therapy initiation and it includes our escalation process if the patient doesn't get their INR tested as scheduled. Our process is to attempt to contact via phone (x2), then a missed INR warning letter, then a referral to social services. The social services referral is intended to help identify barriers that the patient is encountering and to determine if anticoagulation with warfarin is the best option for the patient, considering all aspects of their situation. The social services findings/recommendations are then given to the ordering provider to make a determination on whether to continue therapy (at potentially high risk), modify to a DOAC (if eligible), or take another course of action.

    ------------------------------
    Melissa Quaid BSN RN NE-BC
    Ambulatory Nursing Practice Manager
    Kootenai Health
    Coeur d'Alene ID
    mquaid@kh.org
    ------------------------------

    Original Message


Related Content