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Show Improving Compliance with the Intravenous Heparin Protocol on a Neurocritical Care Unit Bronwynne Castle, BSN, DNP-S, Larry Garrett, RN, MPH, PhD, Cali Wightman, RN, MSN Key Findings: Through nurse education and changes to the nurse handoff tool, compliance with the nurse-driven continuous intravenous heparin protocol improved and event reports decreased on a neurocritical care unit. Background Therapeutic margins for heparin levels are narrow and errors result in coagulation times that are either too short or prolonged, having the potential for serious adverse outcomes. Anticoagulation therapy accounts for 7% of all medication errors in hospitalized patients and heparin accounts for 2/3 of all anticoagulation medication errors. Providing education and effective handoff tools can improve accuracy in heparin administration and increase safety for patients receiving continuous intravenous heparin. Methods Quality improvement project to improve compliance with the nurse-driven intravenous heparin administration protocol. Education tools were developed and implemented to increase understanding of heparin and the IVH protocol. Developed and implemented improvements to the nurse handoff tool for IVH therapy, including information related to protocol type, current lab values, and infusion rates. Nurse Handoff Tool Heparin Protocol: ACS/VTE Current aPTT:__________seconds Next aPTT Time:___________ Drip Rate:___________units/hours Bolus: Y or N Results Over 95% of nurses voluntarily participated in the questionnaire portion of the QI. Four of the 13 questions showed marked improvement, five showed slight improvement, four were unchanged. There were 4/15 adverse events related to IVH therapy pre intervention and 0/26 events post intervention. Fisher’s Exact Test revealed these results to be statistically significant (p< 0.05). Conclusions Adverse events that caused harm to patients decreased following the education intervention and improvements to the nurse handoff tool. Consideration should be given to having all information about the IVH protocol in one location within the electronic health record. Usability: The nursing handoff tool continues to be used after the QI. Barriers: Events that did not lead to patient harm, including missed labs and missed dosing, were not examined and could be the basis for an additional QI project. Pre- and post-questionnaire administered to staff to identify knowledge deficits of heparin and the IVH protocol. Measured responses of the questionnaire and adverse events related to heparin administration. COLLEGE OF NURSING |
