Nurse-Driven Heparin Protocol
In spring 2015, an interdisciplinary task force was formed to evaluate the possibility of moving the practice of managing heparin infusions for adult patients from physicians and advanced practice providers (APPs) to nurses coordinating and providing direct patient care on acute care units.
A protocol for nurse-driven heparin infusion management in the acute medical/surgical adult patients seemed possible. A pilot in the adult ICUs showed favorable results for reducing time to target aPTT result from 26 to 12 hours. This test shows how long it takes a patient’s blood to clot. Heparin generally increases the time it takes for a patient’s blood to clot.
The task force comprised nurses, pharmacists, house staff, attending physicians, laboratory staff and members from the Epic build team.
In addition to data analysis, the team spent time redefining the workflow, electronic health record order set build, flowsheet documentation and purpose.
In the newly developed nurse-driven protocol, the nurse would have five responsibilities:
- Order the aPTTs per protocol (including the first aPTT)
- Adjust and document heparin per protocol
- Notify the physician/APP per protocol (when indicated)
- Place a bleeding precautions sign outside the patient’s room
- Monitor the patient for bleeding
PNS strives to allow nurses to bring forward concerns that ultimately improve the quality of patient care. Prior to go-live, Aaron Franklin, a clinical nurse on 13East orthopedics unit, questioned the education for nurses, such as bolusing through the pump and care of an adverse reaction, and the need for hands-on practice.
Based on his concerns, the Surgical, Neuro, Musculoskeletal and Rehab Departmental Advisory Committee (SNMR DAC) quickly put adjustments into place and the rollout of the protocol was placed on hold. A meeting was called that week to include the PNS president, acting CNO and departmental AVP. Education was revised to include “hands-on” case studies to improve the comfort level and knowledge of clinical nurses managing the protocol.