Download Heparin Documentation Improvement to Safely Manage Heparin Infusions

Heparin Documentation Improvement to Safely Manage Heparin Infusions
Venus Manuel MSN, RN, PCCN; Jay Morrison MSN, RN, CPPS
Vanderbilt Medical Center- Nashville, TN
Background
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Figure 1 Heparin Documentation
Conclusions
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Nursing documentation of intravenous (IV) heparin infusion dose/hold
is essential for patient safety.
Barcode electronic medication administration system is used when
administering medications.
Bar code system is not currently available for continuous IV infusion
doses such as heparin.
Based on Physician feedback, dose documentation provided the most
value in decision making related to heparin management.
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Aim
Heparin documentation change has increased the accuracy of nursing
documentation of heparin.
Placing the intervention within the nurses documentation workflow
yields an increase in documentation.
Targeted education and leadership rounding further increased
compliance and adoption of practice change compared to integration
with the workflow alone.
Heparin dose documentation is now exported to an electronic heparin
dashboard that physicians/providers can easily access (Figure 2).
FIGURE 2 Heparin Dashboard
To increase documentation of IV Heparin Administration (volume and
dose) in the electronic nursing documentation system.
Methods
Identification of Problem
• Adverse patient events that involved heparin infusions reviewed.
• Heparin volume infusion documented every 4 hours, but does not
reflect exact heparin dose administered – starts, stops, or holds.
• Nursing electronic documentation system did not provide a standard
location for nurses to document heparin IV holds or stops.
New Process Implementation
• Method developed to document heparin IV doses & holds (Figure 1).
• Targeted education on new process
• Audits and rounding performed daily for first month of implementation
with immediate feedback to nursing staff
• Implemented October 30th 2012
Settings
• 2 cardiovascular step-down units implemented the new process,
received detailed education and leadership rounding
• All other adult Inpatient units had access to the intervention within their
documentation workflow without specific education or leadership
rounding
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Results
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