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 15 0000. ref SDS 14 0000.
040502 -
040503 -
040504 -
040506 -  ..
0406 -
0407 -
0408 - Background
0409 -
040901 - INR 5.8 Medication Conflict Nortriptyline Acyclovir Prednisone
040902 -
040903 - Follow up ref SDS 15 KE5I, ref SDS 14 KE5I.
040904 -
040905 - On 100202 0830 Millie had a blood draw at Kaiser in Martinez.
040906 - ref SDS 7 AS5H
040908 -  ..
040909 - On 100202 1927 Laurie called yesterday evening and reported INR 5.8,
040910 - ref SDS 8 KE5I, for Millie's blood draw at 0830. ref SDS 7 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 8 KW6Q
040916 -  ..
040917 - On 100203 1023 Gloria, Case Manager Kaiser Coagulation Control Clinic,
040918 - called to order changes in Millie's Coumadin, ref SDS 11 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 11 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 12 QJ85, and is also ordering an interim blood draw to test
040926 - INR on 100205, ref SDS 12 4Q4O, and that the Gloria wants the work
040927 - performed in Walnut Creek. ref SDS 12 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 13 QJ85
040941 -  ..
040942 - On 100204 1325 Millie notifies primary care physician to submit
040943 - results of CA 15-3 test for blood draw on 100202, ref SDS 14 QJ85, and
040944 - to approve Millie for getting interim blood draw through Power Port to
040945 - reduce the risk of complications for Millie's patient profile compared
040946 - with high risk using IV needle penedtratios in the left and right
040947 - arms.
040949 -  ..
040950 - On 100205 0938 Millie notifies medical team that Kaiser failed to
040951 - provide blood draw services that align with her patient profile to
040952 - avoid needle penetrations in her right arm, ref SDS 15 QJ85, and the
040953 - lab resutls today showed INR 3.2 which is significant improvement
040954 - after pausing Coumadin for 2 days. ref SDS 15 IS6U  Millie asks the
040955 - Coagulation Control Clinis to adjust Coumadin medication so that INR
040956 - will decline to a safe level for treating pulminary embolism.
040957 - ref SDS 15 IS7Q
040958 -
040960 -  ..
0410 -
0411 -
0412 - Progress
0413 -
041301 - Gloria called Millie this morning and explained changes in Coumadin
041302 - (warfarin) medication responding to Millie's letter this morning.
041304 -  ..
041305 - Millie received a response letter from Gloria presenting new guidance
041306 - on Coumadin, as follows...
041307 -
041308 -    1.  Subject:  INR 3.2 Returning to Normal After 2 Day Pause with Coumadin
041309 -        Date: Fri, 5 Feb 2010 10:23:14 -0800
041313 -         ..
041314 -    2.  Anticoagulation Service
041315 -
041327 -         ..
041328 -    6.  [Responding to your letter this morning reporting INR 3.2 for
041329 -        the Lab at Kaiser in Walnut Creek also this morning, and
041330 -        requesting guidance on adjusting Coumadin medication to achieve
041331 -        INR safe level for treating pulmonary embolism. [100205 0938,
041332 -        ref SDS 15 IS7Q]
041334 -         ..
041335 -    7.  Thank you for taking your Protime/INR blood test.
041336 -
041337 -        Your INR Result:
041338 -
041339 -            Basename               Value
041340 -            INR                    3.2
041342 -             ..
041343 -            Date/Time............................... 02/05/2010
041345 -         ..
041346 -    8.  Your INR REMAINS SLIGHTLY HIGH:
041347 -
041348 -        YOUR INR GOAL RANGE IS 2.0 - 3.0.
041350 -         ..
041351 -    9.  YOUR NEW WEEKLY WARFARIN DOSE IS:
041352 -
041353 -        Using Warfarin 4MG Tablet (BLUE in color):
041355 -         ..
041356 -        Take 4MG (1 tablet) every Sunday and Wednesday;
041357 -        take 2MG (1/2 tablet) all other days of the week.
041359 -         ..
041360 -   10.  Sunday (mg): 4 MG
041361 -        Monday (mg): 2 MG
041362 -        Tuesday (mg): 2 MG
041363 -        Wednesday (mg): 4 MG
041364 -        Thursday (mg): 2 MG
041365 -        Friday (mg): 2 MG
041366 -        Saturday (mg): 2 MG
041368 -         ..
041369 -   11.  Please have your next Protime/INR blood test on: Follow up
041370 -        date: 2/9/10
041372 -         ..
041373 -   12.  You can test at any Kaiser Permanente lab.  You do not need an
041374 -        appointment or lab slip.  We will contact you by phone or by
041375 -        mail with your results.  If you do not hear from us within 3-4
041376 -        days, please call us at the phone number below.  If at all
041377 -        possible, please do not have your INR lab done on Fridays or
041378 -        weekends unless specifically instructed to do so by the
041379 -        Anticoagulation Clinic.
041381 -         ..
041382 -   13.  **Please call us to report any changes in your medications,
041383 -        diet, health, activity level, any unusual bleeding/bruising
041384 -        symptoms, any dental/surgical procedures and/or any recent
041385 -        missed/extra warfarin doses.
041387 -         ..
041388 -        Thank you.
041389 -
041395 -         ..
041396 -   15.  Kaiser Permanente Anticoagulation Service, Phone (925) 372-1628
041398 -         ..
041399 -   16.  NOTICE TO RECIPIENT:  If you are not the intended recipient of
041400 -        this e-mail, you are prohibited from sharing, copying, or
041401 -        otherwise using or disclosing its contents.  If you have
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041403 -        immediately by reply e-mail and permanently delete this e-mail
041404 -        and any attachments without reading, forwarding or saving them.
041405 -        Thank you.
041406 -
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0415 -