Sarah’s patient had a caregiver leave service. The caregiver had been performing home testing and calling in the INR result to the home testing company. The patient was physically unable to complete INR home testing. Due to physical limitations and lack of support, no one was able to assist in obtaining INR. The patient was not able to travel to the clinic for INR testing. Sarah sent a home testing order to the provider in an attempt to have Home Care come and evaluate for PT/SN as the patient is homebound. Home care declined the referral due to staffing and were not successful in outsourcing to another company. Both Sarah and the cardiology nurse were working to resolve it without success. Sarah contacted her manager for assistance. The manager investigated Senior Health Services, but service was not available at the patient’s location. The manager recommended a home visit. The manager went to the patient’s home and found the machine was old and difficult to use. INR was not successfully obtained. Sarah was contacted, and the manager recommended the Roche machine. Sarah came out to the patient’s home with the clinic machine and was successful in obtaining an INR. The patient was given dosing instructions for elevated INR. Without adjustment, it could have continued to elevate. This could have led to a patient bleed.

Sarah then followed up to ensure the new home testing order went to the home testing company to include a new Roche machine. The patient stated he has caregivers who may be able to use it as it is easier. Sarah continues traveling to the patient’s home for INR to ensure he is safely monitored until a caregiver can be trained, and a new machine obtained.