CONTACTS 

SUBJECTS
INR 6.4 Blood Test 061214 Very High Danger Risk Hemorraging Contiual

0403 -
0403 -    ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000. ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040507 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - INR 5.8 Medication Conflict Nortriptyline Acyclovir Prednisone
040902 -
040903 - Follow up ref SDS 11 KE5I, ref SDS 10 KE5I.
040904 -
040905 - On 100202 0830 Millie had a blood draw at Kaiser in Martinez.
040906 - ref SDS 6 AS5H
040908 -  ..
040909 - On 100202 1927 Laurie called yesterday evening and reported INR 5.8,
040910 - ref SDS 7 KE5I, for Millie's blood draw at 0830. ref SDS 6 848J  Since
040911 - this is 100% above Kaiser's range of safety for controlling Millie's
040912 - pulmonary embolism, Laurie said that Gloria, the case manager for
040913 - Millie's Coumadin treatments, will call today with instructions for
040914 - adjusting Coumadin. ref SDS 7 KW6Q
040916 -  ..
040917 - On 100203 1023 Gloria, Case Manager Kaiser Coagulation Control Clinic,
040918 - called to order changes in Millie's Coumadin, ref SDS 10 QJ85, and
040919 - also ordered an interim blood draw on Friday to retest INR in order to
040920 - further adjust Coumadin on Friday, 100205. ref SDS 10 NT5T
040922 -  ..
040923 - On 100203 1148 Millie notified medical team that the Coagulation
040924 - Control Clinic has ordered a pause for 2 days in Coumadin treatments,
040925 - ref SDS 11 QJ85, and is also ordering an interim blood draw to test
040926 - INR on 100205, ref SDS 11 4Q4O, and that the Gloria wants the work
040927 - performed in Walnut Creek. ref SDS 11 J54T
040929 -  ..
040930 - On 100203 1410 Millie received a call from Arlette who advised that
040931 - the Kaiser Chemotherapy Infusion Clinic has a new policy implemented
040932 - this year to avoid using Power Port technology to perform blood draws
040933 - for INR testing, because Heprin used to maintain port catheters is
040934 - believed to have caused medical problems for some patients who had
040935 - blood drawn from port catheters for INR testing.  To avoid the risk of
040936 - medical problems caused to other patients, Kaiser wants Millie to get
040937 - blood drawn for the INR test on Friday from the Lab in the basement
040938 - which can only use IV needle penetrations which present risks for
040939 - Millie's patient profile. ref SDS 0 QJ85
040940 -
040941 -
040943 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Arlette received a copy of Millie's letter this morning notifying the
041302 - medical team that Gloria in Kaiser's Coagulation Control Clinic has
041303 - ordered an interim blood draw, 100203 1148, ref SDS 11 4Q4O, to test
041304 - Millie's INR 5.8 which soared above safe levels in the test at Kaiser
041305 - in Martinez on 100202 0830. ref SDS 6 848J
041307 -  ..
041308 - Arlette said that she coordinated with the Chemotherapy Infusion
041309 - Clinic team on scheduling a blood draw for Millie on 100205 0730, as
041310 - planned in Millie's letter to the medical team earlier today on 100203
041311 - 1148. ref SDS 11 J54W
041313 -  ..
041314 - The Chemotherapy Infusion Clinic reported introducing a new policy
041315 - after the first of the year, a few weeks ago to avoid performing blood
041316 - draws using port catheters, because a few patients have had medical
041317 - problems.  Kaiser has traced these problems to a possible conflict
041318 - with Heprin used to maintain port catheters after each use, and
041319 - believe that contamination may occur in some way.
041321 -  ..
041322 - Therefore, the Kaiser Chemotherapy Infusion Clinic in Walnut Creek
041323 - prefers to avoid the risk of medical injury from drawing blood through
041324 - ports maintained with Heprin, so wants Millie to get the blood draw
041325 - for INR in the basement Lab that only uses IV needle penetrations, and
041326 - which presents a much higher risk for Millie's patient profile.
041327 -
041328 -        [On 100204 1325 Millie's letter to the medical team asks the
041329 -        primary care physician to enter in Millie's medical chart and
041330 -        notify the Chemotherapy Infusion Clinic that Millie's patient
041331 -        profile requires drawing blood from Millie's Power Port rather
041332 -        than use IV needle penetration balancing very low risks of
041333 -        Heprin contamination in the Power Port which has never occurred
041334 -        in Millie's case over 8 years, against lymphedema recently
041335 -        diagnosed in the right arm which, has prevented IV needle
041336 -        penetrations in the left arm for 8 years. ref SDS 12 SB6S
041338 -  ..
041339 - Millie related that she has routinely been getting blood draws in her
041340 - port for many years without incident.  The new policy was presented
041341 - by the Kaiser Clinic in Martinez a few weeks ago.  They drew blood
041342 - from Millie's port because that is less risky than using an IV for
041343 - Millie's patient profile.
041344 -
041345 -        [On 100205 0938 Doctor Johnson did not have time to align
041346 -        Kaiser practices for Millie's blood draws, with Millie's
041347 -        patient profile, so Millie was forced to get the blood draw
041348 -        with an IV in her right arm despite rising IBC and lymphedema;
041349 -        fortunately, the lab was successful on the first needle
041350 -        penetration, ref SDS 13 IS6R, and the lab reported the test
041351 -        shows INR 3.2, significant improvement after pausing Coumadin
041352 -        for 2 days; Millie asks Gloria for guidance from Coagulation
041353 -        Control Clinic on adjusting Coumadin medicattion. ref SDS 13
041354 -        IS7Q
041356 -         ..
041357 -        [On 100205 1143 Gloria called Millie and sent a letter
041358 -        confirming instructions to resume Coumadin medication to
041359 -        prevent pulmonary embolism, ref SDS 14 QJ85, and adjusting
041360 -        the dose so that INR blood counts decline to a safe level.
041361 -        ref SDS 14 F28V
041362 -
041363 -
041364 -
041365 -
041366 -
041367 -
041368 -
0414 -