Hi all,

Our facility is having a lot of administration errors with heparin drips. We have done tons of education and reminders, but the same mistakes keep happening. We use Epic and it seems the entry is just not nursing friendly. I was wondering if any of you have had the same issues and/or what your heparin entries/builds look like. What mechanisms or procedures do you use to minimize these errors?

The errors include:

1. Not following the protocol correctly for elevated Anti-Xa or PTT (i.e. if PTT >150 and doing Q1H checks until PTT decreases to acceptable range, RN forgets to follow the "elevated PTT" part of the protocol at the bottom and accidentally increases the prior dose instead of decreasing)

2. Heparin drip frequency is entered as "titrate" and therefore no actual due time pops up - multiple RNs have missed starting the drip because of this. If Rx or MD times it to start later in the day, there is no easy way to discern this in the MAR. Even though it is a "titrate" med, do any of you have it entered as "continuous" but with a dose range? So that the due time populates on the MAR?

3. Once PTTs are being checked Qday after being therapeutic, RNs forget to go back to checking Q6H after a rate change

4. After pt returns from procedure, RN accidentally restarts heparin at the initial starting rate, instead of the rate pt was on prior to procedure

Any feedback would be greatly appreciated! And apologies for the lengthy post..

-Saduf