Heparin Dosing Order Form Use in an Academic-Affiliated Veterans Affairs Medical Center

Abstract

Objective: Because a drug utilization evaluation (DUE) showed poor intravenous heparin prescribing practice in our medical center, we developed a preprinted intravenous heparin order form for use by physicians to improve heparin administration. Methods: Two DUEs were performed, one prior to use of a weight-based heparin dosing order form and another after the introduction of the form. Indicators that were evaluated included dosing, laboratory monitoring, and intramuscular injections. DUE results before and after introduction of the order form were statistically compared using Fisher's exact text. Results: The initial DUE showed that only 3% of patients who were administered intravenous heparin received appropriate dosing, and only 60% had a therapeutic activated partial thromboplastin time (aPTT) ratio within the first 24 hours. Blood samples for the aPTTs were drawn at incorrect × in 27% of patients, and 9% of patients received intramuscular injections of other drugs. After implementation of the preprinted intravenous heparin order form, 73% of the patients received appropriate heparin dosing (p < 0.00001), and 79% of the patients had a therapeutic aPTT ratio within the first 24 hours (p = 0.08). The aPTTs were drawn at incorrect × in 12% of patients, and 3% of patients received intramuscular injections (NS for both). All patients receiving appropriate heparin dosing achieved a therapeutic aPTT ratio within the first 24 hours, whereas only 29% of patients on the acute wards and 50% of those in the intensive care units achieved a therapeutic ratio when dosing was inappropriate (p < 0.0001). Conclusions: We improved the intravenous heparin prescribing practice in an academic-affiliated tertiary Veteran's Affairs Medical Center using a preprinted intravenous heparin order form for physician use. The form was also effective in achieving the desired aPTT ratio within 24 hours.