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1. adjustments and sent to the physician for signature Adopted 6 16 2009 Revised 12 2010 2 2012 Reviewed 7 13 Central Valley Health District POLICY AND PROCEDURE MANUAL CENTRAL VALLEY HEALTH DISTRICT uality Control Measures Each time a PT test is performed a Low and High control test is performed automatically by the PT monitor See page 23 of the Professional Users Manual Scheduling Each nurse is responsible for scheduling the time and date she will be using the C INRATIO 2 machine Use of the INRATIO 2 machine will be documented on the calendar located in the CVHD Nursing Lab and designated as the INRATIO 2 calendar Both machines will be available for use on a daily basis Cleaning Maintenance User s Manual page 25 Error Messages Other Information User s Manual pages 25 26 Adopted 6 16 2009 Revised 12 2010 2 2012 Reviewed 7 132. Central Valley Health District POLICY AND PROCEDURE MANUAL CENTRAL VALLEY HEALTH DISTRICT SECTION NURSING POLICY 440 PROTIME INR MONITORING with the INRatio 2 monitoring system POLICY Protime INR monitoring is a service provided with a Dr Order for Home Visit clients who are unable to get out to their private medical clinic for this service In office protime INR monitoring is available only on a special need basis and an appointment and physician orders are necessary for the service This is a full pay service requiring payment at the time the service is provided PURPOSE CVHD will offer in home PROTIME INR monitoring for clients that are unable to go to their regular medical clinic for this service due to difficulty with health status or mobility in getting to the clinic In Office testing will only be done under pre arranged circumstances A Dr order is necessary for this testing to be done PT INR testing is a payment required service PROCEDURE Protime INR monitoring will be done following the INRATIO 2 Prothrombin Time PT System Professional User s Manual Introduction to the Equipment Pages 4 and 5 of the INRATIO 2 Professional User Guide Operating Conditions Machine must be on a flat surface and at room temperature Test Strips must be at room temperature Please Note Do Not leave the machine in extreme hot or cold temperatures The test strips can be stored at room temperature If the machine is soiled clean wit
3. h a damp cloth or 70 Isopropyl alcohol DO NOT IMMERSE Supplies INRatio monitor with 4 AAA batteries and a power cord AC adapter INRatio Test Strips INRatio Strips are compatible with the INRatio 2 PT Monitor Alcohol pads Gauze pads Lancet device Sharps container Gloves Testing Procedure Pages 16 20 1 Machine will be on a flat surface and at room temperature 2 Make sure that test strips are at room temperature 3 Warm hands to increase circulation and wash with soap and water or clean with an alcohol wipe 4 Press and hold the OK button or insert a fresh test strip to turn the meter ON 5 Insert a test strip into the test strip guide on the monitor Test strip should not be opened more than 10 minutes 6 Match the code on the monitor display with the strip code on the test strip pouch or strip container 7 Wait for the monitor to warm up Adopted 6 16 2009 Revised 12 2010 2 2012 Reviewed 7 13 Central Valley Health District POLICY AND PROCEDURE MANUAL CENTRAL VALLEY HEALTH DISTRICT 8 Obtain a fingerstick sample See instructions for Collecting a Fingerstick sample Section 9 page 20 22 for getting the correct sample to perform a test 9 Apply the blood sample to the sample well on the test strip Make sure you apply the sample directly over the green light DO NOT move the monitor or your finger as you apply the sample 10 Wait for the monitor to beep and then count for a few seconds as it performs the test 11 Tu
4. rn the monitor OFF when you are finished testing press and hold the OK button for 2 seconds Remove the used strip when prompted and discard it in a sharps or other puncture proof container Reporting and Recording of test results The client contact and test results as will as any medication changes and necessary follow up will be documented on the CVHD client record on the proper charting forms Upon completion of the testing process the results will be reported to the designated contact person in the ordering physicians office The results may be faxed using the CVHD INRATIO 2 Protime Results form Attachment 1 or telephoned to the clinic depending on the pre arranged preferred mode of communication and the actual test results The need for immediate follow up with the clinic contact person will be based on the acceptable range of results as outlined in the physician order for testing See attachment 2 CVHD Standing Orders for Coumadin Warfarin Therapy The results will be recorded on the Coumadin flow sheet in the LAB RESULTS portion of the clients chart Attachment 3 Any unexpected results should always be followed up with All values outside the target INR range Attachment 2 will be followed up with a call to the attending physician Results of these interactions will be documented in the client s record In the event of medication adjustments a CVHD Physician order form will be completed to indicate the medication
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