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Dosing warfarin

9 Posts

Posted:  20-Nov-2012 12:37
I'm brand new to practice nursing and have been asked to do INR clinics. i've been on a course and spent time with registered practitioner and have yet to do an exam, however my querie is, am i legally allowed to do this? Is it not prescribing?
Please help, i'm sure you can understand my worries

77 Posts

Posted:  21-Nov-2012 08:13
I would think it is prescribing. I also do DVt clinics and get INR reading etc but the GP comes in to dose. In hospital DVT clinics however I know the nurses used electronic dosing so they are not actually prescribing? hope this helps

scotty :)

34 Posts

Posted:  21-Nov-2012 15:13
I wuold urge you to contact the RCN if you are every worried about legal issues like this one. However useful it is to find out what everyone else is doing , it is your registration at stake. good luck.

4 Posts

Posted:  21-Nov-2012 17:05
You could dose within an PGD as long as parameters are clearly set. I work with non-prescribing nurses who dose and supply/administer anticoagulation in this manner. Seek advice from anticoag service and local medicines management advisor.

49 Posts

Posted:  22-Nov-2012 15:52
Hi ,
are you using a reocognised soft ware package like INR star? This tells you the next dose and when to do repeat and if you need to seek a doctor to check dose eg new medicine and your protocol should say how to do this eg if less than .5 from target we tell pt the doctor will check results and ifthey don't here from us by 6pm to take dose from sheet,if inr is more than .5 out we check with a gp before pt leaves( or if pt hard of hearing or confused) inr star will aslo remind you to recheck in 1w if a dose missed or medicine change.
The anticoag at the hospital can also help if a problem and no gp although it depends on what the gp's contract is ie who is responsible for dosing gp or hospital but even if its the gp's they can offer advise.

159 Posts

Posted:  22-Nov-2012 23:00
In our practice we do INR clinics and are working to a PCT protocol which sets out very clearly what to do. We use the coagucheck machine so give the result to the patient and make appropriate changes as per protocol. If we have any queries, we ask the doc on duty for advice. We are changing to the INR star next year and our HCA's will be trained to take over the clinics.

511 Posts

Posted:  24-Nov-2012 12:06 Log in to like this post
A few points:

There is nothing in medicines law to prevent you from altering the dose of a medication which has already been prescribed my someone else. I approached the DH directly about this several years ago and was advised that it is a matter of professional practice, not law - they advised that you have a protocol in place to set out the parameters within which you can work.

A PGD is not appropriate in this situation. PGDs are for when you literally supply or administer medicines so unless you are keeping the warfarin in stock and giving to to the patient, you do not need one.

INR star and similar programmes are decision SUPPORT software, not decision making software. A computer programme works to an agorithm and will not always apply common sense! I often overrule it as I know my patients. However whether you decide to follow it or overrule it, you remain responsible for the decision.

You may find it helpful to contact the anticoag nurses at your local hospital. I would doubt that they are all prescribers and they will probably be able to offer you some support and guidance in this.

Good luck!


3241 Posts

Posted:  24-Nov-2012 14:12
I think that it debatable really. If you as a health care professional see a patient perform a test and then suggest a dose to me (and the NMC) you are prescribing a drug. Its the same with other stuff.Look at vaccines as an example. A patient may be undergoing a course of vaccines that have been prescribed by someone else but if you give it you are still responsible and hence why we use PGDs to negate the issue. Warfarin is one of the top 10 drugs that cause harm to patients and should be treated with extreme caution. This has really set me thinking though.I wonder what the anti coag nurses do?? As you say they cant all be prescribers.I vaguely know someone who is working in anticoag ill email her and ask.
Search the forum for HCAs and warafarin it isnt legal for them to "take it over" each dose will have to be prescribed by the docs or a nursey prescriber.It works like a dream in some practices but in others I know that HCAs are dosing and prescribing warfarin in some as well. Willow


511 Posts

Posted:  24-Nov-2012 18:22 Log in to like this post
I absolutely agree Willow that warfarin should be treated with extreme caution. That is one of the reasons that I really don't think dosing should be done by an HCA following a computer programme as it requires an understanding of what you are doing. Or by anyone else just following a computer programme for that matter - I have known doctors to slavishly follow INR star when it has really not been appropriate to do so.


159 Posts

Posted:  27-Nov-2012 00:00
willow, just to clarify, the HCA's are taking over the clinics, not prescribing. We will be monitoring how the change goes very carefully and they will be supported and trained. It does seem to work well in other surgeries, if not, I guess our nurse manager and GPs will reassess the situation very quickly.
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