Dad's INR 8.7

[warrenr]

Got a call from the nursing home today telling me that my father's INR was 8.7
They are holding his coumadin until Monday when they get new lab results. That means none Sat, Sun, and maybe Mon depending what time they get new INR. What is the protocol for high INR? At what point is it dangerous?

 

[KathyH]

That is a high level. People have told me that they don't worry unless the INR is over 7 (normal is 2.5- 3.5- range for mechanical valve) I know your Dad has had some troubles lately, sorry to hear that. I know my INR was 6.2 2 weeks ago and they held my coumadin for 2 days, next Inr was 2.1. I know AL's phamplet on INRs and coumadin has good information on this. I would call his Dr and ask what his plan was. Sometimes they give vitamin K, but I think they only give it if you are bleeding. I don't want to give you any wrong information. Check the Coumadin site. Sending good thoughts your Dad's way.
Kathy H

 

[Guest]

Holding three doses for an INR of 8.7 is reasonable, particularly for someone who takes less than 5 mg/day. I don't recall your father's warfarin dose.

I am more concerned about why it is that high. For most people finding out why is not a priority because there are too many variables. However, your Dad is in a controlled environment and unable to change much on his own. My guess is that he has an illness - diarrhea, depression causing him to not eat, something requiring antibiotics, fever, or some change in his medications. Almost everyone on warfarin who is admitted to the hospital for an illness has an elevated INR.

 

[geebee]

Warren,

I am sorry to hear your father is having such problems.

If there is not an underlying reason for your father's INR to be so high (like Al said, not eating, nausea, new meds, etc.) you need to be checking into the activities of the nursing home. In such an environment, INR should be very stable unless someone has a medical change.

 

[warrenr]

coumadin overdose

coumadin overdose

The asst. director of nursing at the nursing home called me into her office today for a closed door discussion about my father's INR. She was sweating bullets about what caused dad's INR to jump to 8.7. It turns out that they use agency nurses from a local agency now and then and one of the agency nurses misread dad's chart and gave him 8mg per day for three day's. He is only supposed to get 4mg daily. Luckily one of the staff nurses caught the mistake and that is why they did a stat INR on Saturday. Im just glad that they were upfront about it. After our discussion in which I stayed very calm, she said she couldn't believe I did not jump up and down and scream at her. She did say that the nurse is no longer allowed to practice in there facility. Im just glad one of the staff nurses caught the error. We all know what might have happened. Yesterday his INR was down to 3.8 and they started him back on 4mg daily. In a way I'm glad it was a medication error. I was starting to think that maybe he had a serious liver problem.

 

[RCB]

3 Days!

3 Days!

One day- a mistake. 3 day- irresponsible
I would demand a written report be filed with the state medical board against this "nurse". Your father has been through enough and should not have to put up with this crap.

 

[Nancy]

Warren-

That is an absolute nightmare. I don't buy it that the facility can get off the hook by blaming the agency nurse. Yes, he/she was very, very wrong and could have caused your dad terrible harm. But that facility has oversight responsibilities. RCB is right, a report should be done to the state licensing board.

I hope your dad has no more things happening to him. He's suffered enough and deserves to be able to relax, you too.

I don't know how you kept your composure.

 

[geebee]

I agree with you that it is good they were up front with you. I am sure it makes you feel much better knowing it is not some underlying medical condition.

Unfortunately the idiotic nurse could have killed your father (although I am sure your know that). I would hate to think she might still be out there misreading charts.

I agree that a report should be filed to prevent this from happening again.

 

[catwoman]

Warren:

You must have bitten your tongue off to keep your calm during the meeting. I'm not sure how calm I would have been.

Do the various nurses at this nursing home not have SOME inkling about warfarin? Surely your dad is not the only patient there who is on warfarin. Someone should have questioned 8mg as opposed to smaller doses being given other patients.

Makes you wonder about the training and experience of these agency nurses and if any other patient has received wrong dose or Rx. Of course, the nursing home won't tell you, due to privacy laws and also fear of negative publicity/suits.

Seems this nursing home should consider going to a centralized system of measuring out meds -- so that a few RNs (hopefully RNs) could become more knowledgeable about various meds, interactions, etc. Of course, the officials may say it'd be too expensive.

But -- it would be far cheaper than being hit by a medical malpractice/negligence/wrongful death suit.

 

[KathyH]

Unfortunately, nursing homes are short staffed and often they have agencies they call to send in nurses. The nursing home usually calls the same agencies, but very occasionally they will get a nurse that is not the cream of the crop. I applaud the director for being upfront with you. I am quite sure the director called the agency and should have filed a report on it. I am glad to hear your Dad is back on the right track.
Kathy H