Point-of-Care INR Determination, Coumadin Dosage Changes, and Use of a Historical, Self-Updating Database in a Prison

Coumadin is the most dangerous medicine in common use in primary care medicine as well as in the correctional setting. In the Maryland Division of Correction’s Eastern Correctional Institution, a multivendor collaboration between the medical director and a clinical pharmacist maintained a point-of-care, finger stick international normalized ratio determination using a portable monitor. With an anticoagulation clinic protocol as a guide, changes are considered in the Coumadin dosage and made through the usual procedure. Results are recorded in an electronic patient health record and tracked in a database that shows the current data page as well as updated historical data for each inmate.