Anticoagulant (Coumadin) Therapy Tracking Record Template printable pdf download

Attention Clinical Staff

Coumadin Therapy – Surveyors are focusing on anticoagulant therapy more closely due to recent

incidents of resident harm and immediate jeopardy related to Coumadin therapy. Although not meant

to be all inclusive, here are some of the key issues to take into account when reviewing your policies and

procedures:

•

Physician: Communicate this concern to your Medical Director and attending physician staff.

Ask for their input related to their practice and facility policy. Request their guidance on

providing education for the nursing staff.

•

INRs: It is generally recommended that all residents on Coumadin therapy have INR testing. The

frequency of testing depends on the individual resident (i.e. residents who are going through

frequent dose changes.) Therapeutic INR ranges are usually between 2.0 and 3.5. The

appropriate “number” within this range for a particular individual would depend on what the

anticoagulation was prescribed for. The higher range of 3.5 is used to prevent clot formation as

with residents who have had heart valve replacement whereas the lower range of 2‐3.0 may be

used to control atrial fibrillation.

•

Tracking protocol: Use a tracking sheet for each resident on anticoagulation therapy as an easy

method for all practitioners to readily access information. In addition to drug dose and INR

levels, the sheet should include an area to record communication with the physician related to

the INR level and any additional orders received. See sample form attached. Insure appropriate

policies and documentation related to the reporting of “panic” levels between lab and facility

and between facility and physician.

•

Coumadin and antibiotics: Residents beginning antibiotic therapy, particularly quinolones

which effect INR levels, should be monitored during their course of antibiotic treatment.

•

Dietary: Vitamin K reverses the anticoagulant effect of Coumadin. Many green vegetables such

as broccoli, kale, spinach, peas, and Brussels sprouts should be avoided or eaten in smaller

amounts less frequently. The nutritional supplement Boost and green tea may also have large

amounts of Vitamin K. For a complete list of Vitamin K levels in foods, go to

•

Drug‐Drug Interactions: Explore with the pharmacy ways to increase the level of “alert” to

nurses administering Coumadin when there is a possibility of drug‐drug interaction. Include

alerts for over‐the‐counter supplements which can also react with Coumadin, such as St. John’s

wort, garlic, ginkgo, ginseng and cranberry extract to name a few.

•

Monitoring: All staff, including CNAs, should be aware of those residents on anticoagulation

therapy and instructed to report any increase of or large bruising, nose bleeds and/or dark or

tarry stools immediately as this may be a sign of an abnormal INR. Nurse should report same to

physician.

•

Falls/Head injury: Residents on anticoagulation therapy are at increased risk for subdural

hematoma should they suffer a fall with head injury. Monitor for mental status and conduct

neurological checks on residents who have a head injury, a witnessed fall with head injury and

also for those whose fall was unwitnessed and you cannot determine whether or not they struck

their head.

Anticoagulant (Coumadin) Therapy Tracking Record Template

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