Improve Adherence to the Nurse-Driven Continuous Intravenous Heparin Administration Protocol on a Neurocritical Care Unit

Background: Anticoagulation therapy is associated with high rates of dosing errors, and intravenous heparin therapy accounts for two-thirds of those errors. The therapeutic margins for heparin are narrow, and errors result in coagulation times that are too short or prolonged and can produce harmful or fatal outcomes. A strategy for reducing errors in heparin therapy is utilizing nurse-driven protocols. This project aims to enhance nurse understanding of heparin therapy and improve the nurse handoff tool used to increase compliance with the nurse-driven protocol. Methods: This quality improvement project utilized two interventions: an improvement to the nurse handoff tool used to comply with the nurse-driven protocol and education intervention for the nursing staff guided by a questionnaire. After surveying the nursing staff with a questionnaire about their understanding of intravenous heparin (IVH) therapy, they received an educational intervention about IVH therapy and the new nurse handoff tool. The implementation of the handoff tool followed the survey and education intervention. The questionnaire was repeated immediately following the education intervention and another a month later. The results of the three questionnaires were compared to assess the effectiveness of the education. At the end of three months, the adverse events related to IV heparin therapy on the unit were measured and compared to the number of events in the three months before the intervention to assess the effectiveness of the new nurse handoff tool. Results: Post-intervention nurses demonstrated increased knowledge on 9 out of 13 questions measuring understanding of principles associated with IVH and the IVH protocol. There were 0/26 errors associated with IVH therapy in the post-intervention period compared to 4/15 in the pre-intervention period. Conclusion: The educational intervention appeared to be an effective method to increase nurses' knowledge of IVH and the IVH protocol. The improved nursing handoff tool used for monitoring IVH appeared to decrease errors in delivering IVH.