Abstract 266: Heparin Documentation Improvement to Safely Manage Heparin Infusions

Abstract

Background: Documentation of intravenous (IV) heparin infusion dose/hold by nurses is a vital component in heparin infusion management. The barcode electronic medication administration system is used when administering and documenting medications but precludes the documentation of continuous IV infusion doses such as heparin. Aim: To increase documentation of IV Heparin Administration Documentation in the electronic nursing documentation system. Methods: We reviewed multiple adverse patient events that involved heparin infusions. When discussing these events, we identified a common trend regarding the inability for nurses to document heparin IV doses/holds in the nursing electronic documentation. Although heparin volume infusion is charted every 4 hours, this does not reflect the exact heparin dose that the patient received when factoring heparin hold orders and boluses. With the involvement of clinical informatics, physicians, nurses, and a quality consultant (QC), we developed a method for nurses to document heparin IV doses and holds via the electronic documentation (Figure 1). On October 30 th 2012, two Cardiovascular Step-Down (CVSD) units championed the heparin process improvement documentation. The nurses on these units receive targeted education about the process improvement change. Audits were performed daily during the first month of implementation and periodically by the QC. Electronic communication was also sent out throughout VUH regarding the changes in heparin documentation. Results: Documentation of administered dose increased from 46% to 71% across VUH regardless of the type or level of education to the change. CVSD: Pre / Post n = 16/21 DOSE: 37.5% / 81% Both DOSE & VOLUME: 31.3% / 71.4% HOLD: 75% / 81% Drop Down: 43% use (68.8% annotation) Non ICU Control: Pre / Post n = 12 / 17 DOSE: 16.7% / 41.2% BOTH DOSE & VOLUME: 8.3% / 11.8% HOLD: 50% / 41.2% Drop Down: 11.1% use (88.9% annotation) ICU units were 100% in dose documentation post changes Conclusion: The heparin documentation change has increased the accuracy of the documentation of heparin dose, volume, and hold across VUH. Targeted education has the potential to increase compliance and adoption. The heparin dose documentation is now exported to an electronic heparin dashboard that physicians/providers can easily access.