Education of heparin per pharmacy guidelines to increase compliance, safety, and pharmacists’ management of heparin infusions
Christopher Truong and Braxton Mehl
Presentation Title: Education of heparin per pharmacy guidelines to increase compliance, safety, and pharmacists’ management of heparin infusions
Authors: Christopher Truong, PharmD and Braxton Mehl, PharmD, BCCCP
Facility: Providence Medford Medical Center
Background: Element of Performance 4 of The Joint Commission’s National Patient Safety Goal 03.05.01 requires that hospitals have a written policy that addresses the need for baseline and ongoing laboratory tests to monitor and adjust anticoagulant therapy. Our hospital has a written Anticoagulation Management General Operating Policy for heparin orders managed through nursing or pharmacy. Currently, most heparin orders are nurse-managed and have resulted in lab and dosing errors.
Purpose: The purpose of this project is to educate pharmacists on the Providence Oregon Region Heparin Guidelines as our hospital moves towards increasing pharmacists’ management of heparin infusions.
Methods: Pharmacists were trained in the Providence Oregon Region Heparin Guidelines through an education session and quiz that required application of the heparin guidelines. A post-education survey was administered to each pharmacist that received training. Scores from the survey were tallied to assess the effectiveness of the training. After the session, the heparin-per-pharmacy order was made available at our facility and pharmacists’ adherence to the guidelines were evaluated.
The primary outcome was the results from the post-education survey. Secondary outcomes include the number of heparin per pharmacy orders and adherence to the heparin guidelines by assessing the required baseline and follow-up labs and the appropriate loading, initial, and adjustment doses. Other secondary outcomes include time to therapeutic aPTT, signs or symptoms of bleeding or bruising, and the number of progress notes completed by pharmacists. Primary and secondary outcomes were analyzed with descriptive statistics. This project is IRB approved.
Results: Eight pharmacists completed post-education surveys. The average pre-education survey score was 2.9 out of 5 and the average post-education survey score was 4.4 out of 5, resulting in an average 1.5 score improvement after attending the education session. Pharmacists scored the practice quiz and education session’s helpfulness as 4.4 out of 5 and 4.8 out of 5 respectively.
Between February 20, 2020 and April 9, 2020, there were 11 heparin per pharmacy orders. Pharmacists managed 9 orders and 2 orders were not verified by pharmacy. Required baseline and follow-up labs were ordered in 100% of orders. Appropriate initial bolus and infusion doses were ordered in 100% of orders. Appropriate adjustment doses were ordered in 88.9% of orders. The average time to therapeutic aPTT was 12.68 hours. No signs or symptoms of bleeding were noted. A total of 68 heparin progress notes were completed by pharmacists.
An education session and quiz were effective methods in training pharmacists to a heparin per pharmacy system guideline.
Empowering caregivers to recognize, support, and treat opioid use disorder: an interdisciplinary assessment of knowledge, attitudes, and comfort level pre and post-education
Annette Sprankle and Mika Michaels
Author: Annette Sprankle, PGY1 Pharmacy Resident, PMMC
Title: Empowering caregivers to recognize, support, and treat opioid use disorder: an interdisciplinary assessment of knowledge, attitudes, and comfort level pre and post-education
Background: Substance use disorder affects approximately one in every four hospitalized patients. These patients are often treated for the admitting medical issue without addressing their substance use disorder. A hospital admission provides an opportunity to connect patients to the medical system. Evidence demonstrates that starting medication-assisted treatment in the hospital reduces the risk of overdose upon discharge, rate of hospital readmission, length of stay, and hospital expenditures.
Purpose: The purpose of this study is to assess how providing education to the interdisciplinary team affects their knowledge, attitudes, and comfort level of treating patients with opioid use disorder in the hospital.
Methods: This study has been approved by the Institutional Review Board. A formalized pre-education survey was developed and administered to members of an interdisciplinary team on a voluntary basis. Members include pharmacists, hospitalists, nurses, social workers, and case managers. Attitudes regarding medication-assisted treatment, baseline knowledge, and comfort level of treating patients with opioid use disorder were assessed. Interdisciplinary education modules were developed and presented to the team by the resident including the identification, treatment, monitoring, follow up, and education of patients with opioid use disorder. A post-education survey was administered to reassess the same parameters as the pre-education assessment. Prescribing data for initiation of buprenorphine and methadone was analyzed comparing data for a 3-month time frame before education and a 3-month time frame after education was provided. Pregnant patients or patients under 18 years of age were excluded from this analysis. A Mann-Whitney test was used to analyze each question rated on a Likert scale. A one-tailed test was utilized with a p-value of
Results: Fifty-nine caregivers answered a pre-education survey and nineteen caregivers participated in the post-education survey. All disciplines reported an increase in knowledge base after receiving education. This was determined by question one (p=0.0222), two (p=0.00049), four (p=0.00075), and five (p=0.00706) of the survey. Comfort level measured by question six of the survey was not unanimous for increased comfort (p=0.299). Nurses reported increased confidence in recognizing the symptoms of withdrawal (p=0.0178), comfort asking patients about their withdrawal (p=0.0392) and comfort in administering the clinical opiate withdrawal assessment (p=0.0108) after education. Pharmacists reported increased confidence in speaking to the advantages and disadvantages of buprenorphine versus methadone (p=0.0129) and comfort in providing dosing recommendations (p=0.0402). Case managers and social workers had no change in feelings that there is an adequate outpatient pathway to connect these patients to care upon discharge. No hospitalists participated in the post-education survey. Two patients in three months were initiated on medication-assisted treatment before education. Four patients were initiated in the three months after education was provided.