Resolving discrepant POC PT INR results through an ongoing registered nurse and point-of-care testing coordinator partnership

BACKGROUND: Integrating prothrombin time (PT) international normalized ratio (INR) results from a variety of clinical and home settings compounds the already-delicate decision making involved in therapeutic warfarin dosing. METHODS: Anticoagulation clinic testing was in the therapeutic range for a patient on warfarin, although results from a home health care service showed otherwise. Prothrombin time INR results performed with home health care service did not change as warfarin dose was adjusted. The point-of-care coordinator (POCC) verified the registered nurse's adherence to the University POCT Compliance Program, use of POC formulary-approved device, operator competency, and recent device comparison to the clinical laboratory. Interviewing the home health care service management, the POCC discerned that, although in-field training and competency-based observation of technique was conducted, the results of the PT INR device were not compared with an accredited clinical laboratory. RESULTS: Owing to patient safety issues related to potential erroneous warfarin dosing, the anticoagulation clinic stopped using any non-University PT INRs to monitor this patient's therapy. Although primary care providers, as well as the anticoagulation team, assumed that the home health care testing was on par with their own testing, this was found to not be the case. Additional processes are being implemented in the primary care clinics to support the physicians monitoring anticoagulation therapy, including increased referrals to the anticoagulation clinic and a case-by-case review in home health care utilization. CONCLUSIONS: The partnership established between a POCC and the direct care staff improved the treatment outcome for a patient in an anticoagulation clinic.