Magazine article Drug Topics

Hospital Improves Safety by Focusing on Heparin, Warfarin

Magazine article Drug Topics

Hospital Improves Safety by Focusing on Heparin, Warfarin

Article excerpt

Errors related to intravenous heparin administration in cardiac patients were reduced by 66% through a program developed by the pharmacy and nursing departments at Fairview Southdale Hospital in Edina, Minn. The program was one of several presented at a conference on patient safety in Chicago sponsored by the National Patient Safety Foundation (NPSF) and the Joint Commission on Accreditation of Healthcare Organizations.

The program was awarded the NPSF's Award for Innovative Clinical Solutions, which is underwritten by the 3M company The original objective was to reduce errors by 80%. The actual reduction of 66%, from .81 to .29 per month was achieved by a combination of changes in procedures, according to Steven B. Meisel, Pharm.D., assistant director of pharmacy at the hospital.

The changes included developing a combined heparin order form and documentation tool, converting all heparin protocols to pharmacy-managed protocols and instituting pretyped heparin orders, improving communication with the laboratory, double-checking pump programming, and encouraging the use of low molecular weight heparin (LMWH) in place of heparin. Meisel said the use of LMWH had proven to be as effective as heparin for most indications. It requires no IV pumps or lines, no dose adjustment, minimal lab testing, and minimal interdepartmental communication. It reduced the number of steps involved by 50%, he noted. The substitution strategy is being promoted through consultations with the medical staff and use of pre-typed orders.

The remaining problems with the use of IV heparin related to errors in programming pumps, Meisel said, and these have been made the focus of a new improvement project. The new approach has proven to be less time consuming and leads to fewer communication errors and better monitoring, he said. It also resulted in greater staff satisfaction, he noted.

In another program at the same hospital, specially trained R.Phs have helped reduce warfarin failure rates by assuming full responsibility for monitoring and treating patients referred to them by the Minnesota Heart Clinic, a 20-physician group. In 1995-96, there were 1.7 admissions per week for warfarin-associated bleeding, according to Kimberly Bahma, Pharm.D., clinical pharmacy specialist at the hospital. This resulted in an average of 6.5 days spent in the hospital at an average cost of $15,590. …

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