Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

I am a charge nurse on a skilled care unit. We have one resident in particular on warfarin and we can’t seem to regulate the INRs. Can you give me some ideas on how to assist with solving this problem?

The first thing you should do is have an IDR meeting, and meet with the entire team, including housekeeping, maintenance, activities, administration, the family — I mean everyone! 

Many times before you change the medication and do many different things to regulate the INR, the solution may be quite simple.  

I once had a family member who owned a nut farm in California and shipped seasonal nut varieties to the resident as a way to allow him to have his favorites. The resident’s INR went crazy. However, the problem was not with staff, but rather the friendly nut shipments from his son. 

By bringing together the entire team you can use this time not only to teach about what foods and drugs can alter the INR results, but to discuss what happens if this resident falls, and the excess bleeding that may occur. 

In addition, activities that allow the resident to use scissors or cutting instruments should be monitored closely. Is there a first-aid kit near the activities room? Who responds to accidents in activities, the dining room and the gym? It is always great to have clear-cut policies in place before you need them. 

The family also can get involved with these discussions, as sometimes they bring in knives or large scissors, not knowing or thinking about the possibility of excess bleeding if/when a cut occurs. 

When the team works together like a well-oiled machine, it provides better quality of life/care for the resident involved — and less stress for staff.