During the Covid-19 pandemic we want to keep warfarin testing (INR) as safe as possible. The following information is to help you maintain safe testing.
If a patient attends your pharmacy with symptoms; fever, sore throat, cough or difficulty breathing, they should be sent home immediately and advised to contact Healthline. DO NOT do an INR test. Advise the patient to call when the symptoms have resolved.
Longer testing Intervals
Many of your patients are elderly and we do not want them to come to the pharmacy more frequently than necessary. For some patients it may be appropriate to extend the testing interval to 3 months, if they have stable control and have been on the same dose of warfarin for 2 to 3 months. It would be sensible to review your patients to see if you have any tests you can delay.
You probably already have reasonably safe testing methods, but I will outline the steps to ensure testing is as safe as possible.
- Ensure that patients who are waiting are at least 2 metres apart. If possible, schedule patients so they are not waiting with other people.
- Do not shake hands with your patient.
- Wash your hands. Use soap and warm water and ensure you wash for at least 20s (the time to sing “Happy Birthday” twice). See this video for correct hand washing.
- Ask your patient to wash their hands. Again, use soap and water for 20s. Ensure they wash their fingers as you are about to hold them! Make sure you wait for their hands to dry.
- Prepare for the test.
- Wash your hands again immediately before you touch the patient. Hand-sanitiser is ideal at this step if available.
- If you routinely wear gloves put them on at this stage.
- Put the test-strip in the Coaguchek and do the finger-prick test.
- When you have finished touching the patient, remove your gloves and wash your hands again (hand-sanitiser if available).
- Review the result and advise the patient about dosing. Give the patient the calendar.
- When the patient leaves, wash your hands again (hand sanitiser or soap and water).
- If you are leaving the room after testing, wash your hands again.
Gloves and Masks
Currently (as of 20 March 2020) there is no recommendation to use gloves or masks when testing asymptomatic patients. Some of you may routinely use gloves for testing. Be careful removing gloves as the outside can be contaminated. Even if you use gloves we recommend you still wash your hands before putting them on and after removal. Masks have some benefit if they are worn by the patient as they can reduce droplet spread, but symptomatic patients should not be tested in your pharmacy. Masks do not offer much protection if you wear one yourself. If you feel more comfortable wearing a mask and gloves there is no reason why you shouldn’t. There is some concern that supplies of masks may be limited in future, so inappropriate use should be avoided.
These recommendations could change as the pandemic evolves.
Will warfarin control be affected by the virus infection?
At this stage we are not sure how much the INR result is affected by the infection. However most viral infections can have some effect, usually giving a higher INR reading. Patients with severe COVID 19 infection could develop serious clotting problems in which case warfarin will need to be stopped by the prescriber/hospital.
If you are asked to test a symptomatic patient, advise the patient to contact Healthline on 0800 358 5453. They will need to go to a safe facility to have a blood test. Do not invite a patient with symptoms to your pharmacy.
Remember that regularly washing your hands and staying away from other people is the best way to keep safe.
Dr Paul Harper, MD, FRCP, FRACP. Approved by the Pharmaceutical Society of New Zealand