Clinical audit of Heparin use in Rift Valley General Hospital, Nakuru County, Kenya
Abstract
Background: Heparin is a high risk medicine that may cause significant harm if not used properly. It is ranked among the top 5 “high alert” medications by the Institute of Safe Medication Practices because of its low therapeutic index and potential for serious adverse outcomes. Adherence to guidelines and protocols, as well as careful monitoring of heparin use, is important in maximizing benefits of its use and minimizing on harm.
Objective: The aim of this study was to examine the processes and outcomes of heparin use in adult in- patients at the Rift Valley General Hospital through the conduct of a clinical audit.
Methodology: A structured clinical audit tool was developed through consolidation of information from various sources. The structures supporting heparin use were physically assessed, including the availability of policies, guidelines or protocols, protamine and laboratory reagents. The processes and outcomes of its use were audited through the prospective observation of heparin dosing, administration and monitoring among eligible adult in-patients.
Results: Clinical audit revealed there were no policies, protocols or guidelines to guide heparin use at Rift Valley General Hospital. Delayed or lack of heparin monitoring were observed. Heparin termination was done well by introduction of warfarin at least three days before stopping heparin in majority of the patients. The overall clinical audit score at Rift Valley General Hospital was 60.6% which showed minimal compliance to the performance threshold/standard of heparin use.
Conclusions: Clinical audit for heparin use in RVGH concluded inadequate compliance to the set standards. There is need to avail guidelines, protocols or policies in the institution and conduct regular monitoring to ensure use of heparin is improved and maximum benefit is realized.
Key words: Heparin, clinical audit, monitoring.
References
Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C, Scott A, Brzostek T, Kinnunen J, Schwendimann R, Heinen M, Zikos D, Sjetne IS, Smith HL, Kutney-Lee A. Patient safety and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United states. BMJ. doi: 10.1136/bmj.e1717..
Baglin T, Barrowcliffe TW, Cohen A, Greaves M (2006). Guidelines on the use and monitoring of heparin. Br. J. Haematol. 133:19–34.
Claudia DG, Janice D, Donaldson C, et al (2015). Self-assessment and action plan. ROP - Heparin Safety. Accreditation Canada.
Douglas A, Udeh BL, Hata JS, Udeh CI (2013). Heparin-induced thrombocytopenia : a clinical and economic review: OA Anaesth.; 1:3.
European Medicines Agency (2011). Guide on the interpretation of spontaneous case reports of suspected adverse reactions to medicines- key considerations. 44: 2 ̶ 4.
Greaves M, Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis (2002). Limitations of the laboratory monitoring of heparin therapy. Scientific and Standardization Committee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis. Thromb. Haemost. 87:163-4.
Health Care Quality Quest Ltd (2009). Clinical Audit Objectives, Quality. Pp 1 ̶ 7
Hirsh J, Anand SS, Halperin JL, Fuster V (2001). Guide to Anticoagulant Therapy : Heparin: a statement for healthcare professionals from the American Heart Association. Circulation. 103:2994–3018.
Institute of Safe Medication Practices, ISMP list of high-alert medications in Acute Care Settings. ISMP Medication Safety alert. November, 2011.
Kearon C, Kahn SR, Agnelli G, Goldhaber S, Rascob GE, Comerota AJ (2009). Antithrombotic Therapy for Venous Thromboembolic Disease. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 133: 454S-545S.
Kenya. Clinical Guidelines for Management and Referral of Common Conditions at Levels 4 – 6 : Hospitals. Ministry of Health; 2009; 30-31.
Moore K, Raval J, Harris Z (2013). A Re-Audit of Chronic Obstructive Pulmonary Disease (COPD). Available at www.nice.org.uk (Accessed October 2016).
NHS. Implementing NICE guidance for Venous thromboembolism: reducing the risk: 2010; 1-2
Quigley FG, Jamieson GG, Lloyd JV, Faris IB (1988). Monitoring of heparin in vascular surgery: J. Vasc. Surg. 8:125-7.
Royal Hospital for Women. Heparin induced thrombocytopenia syndrome (HITS): recommended local operating procedure – assessment and management: Quality and Patient Safety Committee. 2015; (February): 4–6.
Vats V, Nutescu EA, Theobald JC, Wojtynek JE, Schumock GT (2007). Survey of hospital for guidelines, policies and protocols for anticoagulants: Am. J. Health Syst. Pharm. 64:1203-8.
Full Text: PDF
Refbacks
- There are currently no refbacks.