Aim
HERCULES is a collaborative multidisciplinary team (ICU outreach medical, nursing and pharmacy) which aims to improve safety of patients on IV heparin infusion with the following objectives:
- reduce episodes of supratherapeutic activated partial thromboplastin time (APTT) - a blood test that indicates the level of heparin in the blood
- decrease time to therapeutic APTT
- increase percentage of time in therapeutic range
- improve continuity of care (especially after-hours)
- improve education on IV heparin
- improve on documentation for IV heparin review
- to troubleshoot problems resulting in low APTT prior to rate adjustment
- monitor for heparin induced thrombocytopaenia and thrombosis syndrome (HITTS).
Outcomes
A 24/7 round the clock management of patients on IV heparin by a dedicated team using existing resources to improve quality and continuity of care, provide closer monitoring, identify and troubleshoot issues and prevent over-anticoagulation.
Background
Heparin is an anticoagulant (blood thinner) used to treat major clotting disorders in the hospital setting. Like most anticoagulants, heparin is a high-risk medication with complex pharmacology that requires close monitoring. Under-dosing will lead to worsening of clotting disorders while over-dosing leads to bleeding complications.
Junior doctors are often the ones prescribing and monitoring heparin therapy. Unfortunately, most do not have the experience with this complex medication, and most do not use it frequently enough to acquire the necessary volume of practice to be proficient in its use.
Multiple incidents and near misses with IV heparin have been reported locally and at health service level. These include dosing errors, over-anticoagulation, bleeding, requirement for transfusion and poor efficacy as a result of fluctuating APTT level. These incidents occurred despite adherence to the existing Statewide Heparin protocol. Thus, there was an urgent need for a different approach.
