This week in reviewing resident charts discovered a problem with elevated INR results due to coumadin for three of the residents we were reviewing. Modern pharmaceuticals are phenomenal however they also bring risks. To keep a resident safe it is everyone’s responsibility to be vigilant to the potential untoward effects. The residents INRs were above therapeutic ranges measuring from 2.3 up to 9. In researching possible causes learned that simivastatin can increase results of an INR. Two of the three clients were taking simivastatin. When developing a care plan there should be directions for teaching the resident what signs to watch for and report to the nurse, directions should include indications for which caregivers should be alert and when the resident should be seen by the doctor or sent to the hospital.