No way to check PT

[NEPain]

I've just started in a practice with several sites in really rural locations. For patients on coumadin they have them hold it for 3-4 days and do the procedure. I'm so used to checking a PT that this is a little weird for me, especially on cases like cervical epidurals.

The problem is that there really is no reasonable way for many of these patients to get a PT without major inconvenience. Does anyone know if something like an ACT (although it's used for heparin effect) or something else would be an option?

I'm not so concerned with facets, SI's, etc. What about caudals, LESI's, CESI's?

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[bedrock]

I've just started in a practice with several sites in really rural locations. For patients on coumadin they have them hold it for 3-4 days and do the procedure. I'm so used to checking a PT that this is a little weird for me, especially on cases like cervical epidurals.

The problem is that there really is no reasonable way for many of these patients to get a PT without major inconvenience. Does anyone know if something like an ACT (although it's used for heparin effect) or something else would be an option?

I'm not so concerned with facets, SI's, etc. What about caudals, LESI's, CESI's?

you can buy a point of care finger stick PT/INR machine. I wouldn't skip on confirming those PT/INRs.

You can also just tell the patients they have to go to the nearest lab the day before. There has to be a lab within 40 miles of you, right?

 

[Jcm800]

you can buy a point of care finger stick PT/INR machine. I wouldn't skip on confirming those PT/INRs.

You can also just tell the patients they have to go to the nearest lab the day before. There has to be a lab within 40 miles of you, right?

Ditto. You gotta check it. There has to be hospital somewhere or a medical cent with a lab...

 

[101N]

Ditto. You gotta check it. There has to be hospital somewhere or a medical cent with a lab...

Double, Ditto. Few years back I had a nice old dude who swore up and down that he'd stopped his Coumadin 5d prior. Got the INR 3.2.

You can't trust patients recollection. Buy one of those portable finger stick PT thing-a-ma-bobbers or have the local coumadin clinics do so and you use it when you are at the facility.

http://www.inrselftest.com/content/patients/meters

 

[Pain Applicant1]

Get a CLIA waived certificate and buy coagucheck or protime

 

[NEPain]

Thank you all. That's kind of what I thought but I didn't realize there were portable checkers available. Very grateful.

 

[PMR 4 MSK]

Also you get schmucks like I had this week for a CESI.

"Forgot" to stop his coumadin last week for the CESI. Day of the injection, he shows up, didn't even get the PT/INR. Staff didn't even let him past the front desk.

Rescheduled for this week. Day before my nurse calls him and asks him when the last day was he took his coumadin. "I'm not sure." Gets the INR the next day and it's 1.0. I bet he hadn't taken it in at least a full week. *******. He gets one more strike and he's fired for being an idiot.

 

[SSdoc33]

He gets one more strike and he's fired for being an idiot.

you mean one more "stroke", right?

 

[NEPain]

Trying to find a unit for the office(s).
Does anyone know if we could bill for checking the PT?

 

[facets]

Yes, MC will pay you a whole $5, the disposable thingies are $6 and the unit can be found for around $500

 

[lobelsteve]

Some folks give you the machine for free and charge you just for consumables. With mc payment the break even point used to be 60 tests per month. That was 2003. Sure it's worse now.

 

[Jcm800]

Some folks give you the machine for free and charge you just for consumables. With mc payment the break even point used to be 60 tests per month. That was 2003. Sure it's worse now.

yeah that sounds right. we looked into it a few years back, but couldnt come up with the numbers to make it worth it. Unless you can share it, its pretty tough to make the numbers work, unless you are out in BFE, then its worth the few bucks you loose on it...

but given the option of a lab around the corner, from cost perspective, it didnt work for us...

 

[Tenesma]

patients cannot be trusted - they forget frequently and then lie/mis-state because they don't want the procedure cancelled - at least 2 times per month i have to re-schedule a procedure due to INR>too high... so yeah... you gotta check it, and in my experience 3-4 days doesn't cut it, it has to be 5 days...

 

[PMR 4 MSK]

patients cannot be trusted - they forget frequently and then lie/mis-state because they don't want the procedure cancelled - at least 2 times per month i have to re-schedule a procedure due to INR>too high... so yeah... you gotta check it, and in my experience 3-4 days doesn't cut it, it has to be 5 days...

Also, make sure to be clear with the patient as to when the last day is for a pt to take their coumadin. If you tell someone to stop the med for 5 days, for a procedure on the 15th of the month, they don't know if 5 days counts the 15th, or the 10th, or what. Also be sure to tell them to restart it. I have them restart it the day of the procedure.

 

[Ducttape]

Also, dont forget to tell them when NOT to take their coumadin or platelet altering meds... like during a stim or pump trial...

do ppl use V58.63 for monitoring PT?

 

[101N]

Also, make sure to be clear with the patient as to when the last day is for a pt to take their coumadin. If you tell someone to stop the med for 5 days, for a procedure on the 15th of the month, they don't know if 5 days counts the 15th, or the 10th, or what. Also be sure to tell them to restart it. I have them restart it the day of the procedure.

This is a good point. It is important enough to have it stated in your discharge instructions.