1. Planned Implementation Date: June 18, 2013
NEW Heparin Protocol
Planned Implementation Date: June 18, 2013

2. Situation: Several serious errors involving heparin infusions have occurred across UW Medicine.
Background:
Challenges:
Different units of measure used at UWMC and HMC
No fixed-rate option on current powerplans
Inconsistencies in weight used for dose calculations and Alaris pump programming
Why Change?

3. Why Change? Assessment: Recommendation:
Different powerplans between HMC and UWMC:
Dosing units:
HMC – units/kg/hr
UWMC – units/hr
Heparin dosing algorithms
Recommendation:
Standardize across UW Medicine and utilize the best practices from each institution to improve patient outcomes and minimize medication errors related to heparin.
Practice Changes:
Provider ordering
Nurse management
Why Change?

4. New Heparin Powerplans
Providers will choose from two Powerplans:
“Standard Protocols”
RN adjusts rate based on algorithms linked to powerplan
Almost ALL heparin infusions will be ordered this way.
“Provider Managed”
Practitioner completes an order for EVERY rate change
RN adjusts rate based on practitioner order.
New Heparin Powerplans

5. Standard Protocols: Provider Ordering
Provider selects “Standard Protocols” Powerplan:
Provider chooses a sub-phase based on the indication for use of heparin

6. Indication-based Ordering
Indication-based heparin ordering with standardized dosing.
Indication-based Ordering

7. Standard Protocols: Provider Ordering
Selects loading bolus, if warranted
Selects infusion by goal PTT
REGULAR intensity (goal PTT: )
LOW intensity (goal PTT: 60-80)
Selects PRN re-bolus for low PTT, if warranted
If PRN Re-Bolus ordered, BOTH must be checked. Page provider to clarify if only 1 is ordered

8. Algorithm Changes Name: Regular vs. Low Intensity
PRN re-bolus: RN must review PRN medication section to see if ordered and what dose to give
Dose adjustment
Monitoring frequency
Algorithm Changes

9. *NEW* Protocol for PTT>200
For management of PTT>200: See reference text
PTT
CHECK TIMING OF SAMPLE
INSTRUCTIONS
> 200 (potentially contaminated or improperly timed sample)
If < 6 hours since most recent bolus or rate change
Continue infusion at current rate, and repeat PTT at the appropriate time.
If > 6 hours since most recent bolus or rate change
TURN OFF HEPARIN INFUSION. Repeat STAT PTT immediately using peripheral blood draw. If repeat PTT < 200, resume heparin according to heparin algorithm. If repeat PTT > 200, follow steps below.
> 200 (properly timed, non-contaminated sample)
TURN OFF HEPARIN INFUSION, and NOTIFY PROVIDER. Repeat STAT PTT hourly using peripheral blood draw until PTT < 100. Then, resume infusion at DECREASED dose that is 4 units/kg/hr lower than previous dose and repeat PTT in 6 hours.
*NEW* Protocol for PTT>200

10. Provider-Managed: Ordering
Selection of Provider Managed powerplan
Selection of desired subphase
Provider may order in either weight-based or non-weight based units (i.e. units/kg/hr vs units/hr)

11. Provider-Managed: Practitioner orders every dose adjustment.
Practitioner may order:
Weight-based dosing in units/kg/hr
NON-weight-based dosing in units/hr
NOTE: Provider can document desired algorithm to follow for rest of the team in a Clinical note if necessary - but NOT under Infusions Instructions of the heparin infusion order or a nurse communication order

12. Provider Managed Treatment:
For RN Review:
Notice where ordered dose will appear for nursing.