CoaguChek XS (INR): November 2025 Competency

Why accuracy matters: The International Normalized Ratio (INR) standardizes clotting time to guide anticoagulation therapy (most commonly warfarin). Both over-anticoagulation (INR too high) and under-anticoagulation (INR too low) carry significant risk. The CoaguChek XS provides rapid, reliable INR results from a capillary sample when used correctly. This competency validates accurate technique in specimen collection, device handling, quality control, and reporting consistent with laboratory standards.

Infection Prevention & Patient ID

• Perform hand hygiene; apply gloves; follow standard precautions.
• Use two patient identifiers (full name, DOB) and verify orders per policy.
• Clean the fingertip site with alcohol; allow to dry completely before puncture.

Device Preparation

• Confirm device is functional; batteries adequate; date/time correct.
• Verify test strip lot & expiration; store per manufacturer specs.
• If applicable, insert the correct code chip for the lot in use.
• Warm patient’s hand to promote capillary flow; position hand below heart level.

Specimen Collection (Capillary Fingerstick)

• Use a single-use safety lancet on the lateral side of a warm fingertip.
• Do not “milk” or excessively squeeze the finger (can dilute with tissue fluid and skew INR).
• Wipe away the first drop; collect a large, free-flowing second drop.
• Apply sample to the test strip promptly per IFU; ensure the target fills correctly without smearing.
• Avoid delays > 15 seconds between lancing and application (clot activation can alter results).

Quality Control (QC) & Result Validity

• Run external QC per agency schedule (new lot, new shipment, after service, as required).
• Do not use expired strips or controls; document lot/exp dates in the log if required.
• Recognize and respond to device prompts/errors (e.g., insufficient sample, strip error).
• Be aware of known interferences (e.g., extreme hematocrit, improper sample collection, high triglycerides); follow policy for lab confirmation when indicated.

Result Review, Critical Values & Next Steps

• Compare result to the patient’s therapeutic range (per prescriber/anticoagulation protocol).
• Critical high/low results: follow agency notification thresholds and immediately escalate to the ordering provider/anticoag clinic.
• When results are unexpected, inconsistent with clinical picture, or the test process was compromised, repeat once. If still discordant, obtain a venous INR per policy.

Documentation Expectations

• Record INR value, date/time, strip lot (and control lot if used), and any repeats/errors.
• Note patient status relevant to testing (diet/med changes, missed doses, illness, bleeding/bruising, new antibiotics).
• Document provider notification and any instructions given (dose changes, recheck interval) per protocol.

Common Errors to Avoid

• Applying a small or smeared sample; allowing alcohol to remain wet at puncture site.
• Delays between lancing and application; excessive squeezing of the finger.
• Testing with expired strips or mismatched code chip (if applicable).
• Failure to warm the hand or position below heart level, resulting in poor flow.

Supplies at the Station

• CoaguChek XS meter(s), test strips (in-date), code chip (if required for lot).
• External controls (if running QC), single-use safety lancets, alcohol pads, gauze, bandages.
• Gloves, sharps container, disinfectant wipes for device and surface.

Validation process: If the first attempt is not satisfactory, you’ll be asked to review the contents found here, and then return for a second attempt during your session (as time allows). If still not satisfactory, you’ll be scheduled for 1:1 remediation on November 19, 2025 between 8:00 AM and 10:00 AM, per the standard process.