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. 2021 Jan 1;78(1):49-59.
doi: 10.1093/ajhp/zxaa342.

Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Kalynn A Northam  1 , Sheh-Li Chen  1 , Andrew P Stivers  2 , Jonathan D Cicci  1 , Tanner L Hedrick  1 , Marian A Rollins-Raval  3 , Raj S Kasthuri  4
Affiliations

Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Kalynn A Northam et al. Am J Health Syst Pharm. .

Erratum in

  • Correction Notice.
    [No authors listed] [No authors listed] Am J Health Syst Pharm. 2022 Feb 18;79(5):403. doi: 10.1093/ajhp/zxaa430. Am J Health Syst Pharm. 2022. PMID: 33595058 Free PMC article. No abstract available.

Abstract

Purpose: Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin administration. Management strategies are complex and include discontinuing heparin products, initiating alternative anticoagulants, interpreting laboratory test results, documenting heparin allergies, and providing patient education. Medication error reports and a retrospective review conducted at an academic medical center revealed an opportunity for a quality improvement initiative and led to the creation of a multidisciplinary workflow for the management of HIT. In a pre-post study, the impact of the multidisciplinary workflow on the safety and management of HIT was evaluated.

Methods: The preimplementation group consisted of adult patients tested for suspected HIT from April 4, 2014, through May 31, 2016; the postimplementation group consisted of adult patients tested from November 1, 2016, through October 31, 2018. The primary outcome was the incidence of heparin product administration while HIT testing was ongoing. The secondary outcome was the rate of appropriate heparin allergy documentation.

Results: The incidence of heparin product administration while HIT testing results were pending was significantly reduced, from 54.2% to 20.0% (P < 0.001), after workflow implementation. The rate of appropriate heparin allergy documentation significantly increased, from 95.0% to 100% (P < 0.001).

Conclusion: Implementation of a multidisciplinary workflow for the management of HIT significantly reduced the incidence of heparin administration while testing was ongoing and improved the rate of appropriate heparin allergy documentation.

Keywords: anticoagulants; documentation; heparin; quality improvement; thrombocytopenia.

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Figures

Figure 1.
Figure 1.
Postimplementation multidisciplinary workflow for management of heparin-induced thrombocytopenia (HIT). EHR indicates electronic health record.
Figure 2.
Figure 2.
Implementation barriers and corrective EHR modifications performed in each plan-do-study-act cycle during the postimplementation period. EHR indicates electronic health record; HIT, heparin-induced thrombocytopenia.
See this image and copyright information in PMC

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