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How to Reduce Heparin Drips Administration Errors

Lianet Aroche

Florida National University

Nursing Research

05/28/2022

How to Reduce Heparin Drips Administration Errors

Introduction and problem statement

Heparin is an anticoagulant drug used for various uses, including thromboembolic prophylaxis and treatment and the management of central venous access. It comes in different concentrations (1000 units/mL or greater) for therapeutic and prophylactic usage and lower concentrations, that is 100 units/mL or less, used in heparin lock flushing solutions. Heparin administration is greatly associated with medical errors resulting in severe consequences on patients’ health (Warnock & Huang, 2019, p. 49). Three high-profile occurrences involving this medicine at three prominent US institutions brought safety concerns about heparin use to the forefront. The Joint Commission’s National Patient Safety Goal (NPSG) 03.05.01, “lower the chances of patient harm due to anticoagulant medication use,” emphasizes the safe anticoagulant therapy use and monitoring.

Despite a previous attempt in a large Midwestern hospital to develop standard heparin administration procedures using a computerized system, errors continued to occur at unacceptably high rates. Heparin Error Reduction Workgroup (HERW) was formed in 2002, by pharmacists, staff nurses, and cardiologists. The HERW hired consultants of human factors to conduct an analysis of the human factors process of heparin administration among the nursing staff (Treiber & Jones, 2018, p. 159). Between 1999 and 2003, heparin was the most commonly used medicine in 14,800 ED medication mistakes.

Heparin is a medication that, if used wrongly, can result in serious hemorrhagic complications. Over five years, heparin dosing in large metropolitan hospitals with evolution has become more difficult. Heparin was formerly prescribed and monitored unevenly by physicians (Lee & Riley, 2021, p. 515). Heparin dose regimens were established and applied to ensure standardized dosing, optimized therapy, and reduced hazards. The dosing methods grew in number as heparin administration became more sophisticated and patient-specific. The protocols were originally only available on written paper. The benefits of computerized access in drug administration were exploited to improve protocol delivery and boost upgrade efficiency. Interactive computer software was developed to make protocol usage easier.

Three premature newborns died due to drug errors in an Indiana hospital that drew national attention. The Heparin overdoses were accidentally given to newborns because the incorrect strength was utilized to prepare umbilical line flushing solutions. The mistake occurred when 1 mL vials were accidentally put in a unit-based automated dispensing cabinet (ADC) where heparin 10,000 units/ml, 1 ml vials were commonly kept (Lee & Riley, 2021, p. 519). Nothing can take away the families’ pain in the aftermath of this unfortunate tragedy, and this keeps reminding us of the necessity to take precautions and closer examination of heparin use in our institutions.

The use of heparin includes;

· Prevention of enlargement of existing clots.

· Treatment and prevention of pulmonary emboli and deep venous thrombosis (Warnock & Huang, 2019, p. 49).

· Decreasing the risk of the development of blood clots.

· Maintaining patency of indwelling venous catheters.

The significance of Heparin administration errors administration to nursing.

Medicine errors can happen during any stage of the process of medication administration, including prescribing, transcription, dispense, and administration. However, previous researches have shown that pharmaceutical errors are more frequent during the phase of drug administration. This is because nurses administer the majority of the drugs. Heparin, for instance, is commonly administered and monitored by nurses (Warnock & Huang, 2019, p. 49). The nurses receive the clients’ medication upon prescription and dispatch and administer. Nurses can ensure improved patient safety through interruption of medication errors before reaching the client through adhering with six drug delivery rights and reporting of the problem.

Nurses confront problems in many facets of their work, particularly when safely providing and monitoring medications. General drug information and knowledge, formal nursing education, continuous education needs, clinical area experience, and nursing shortage nationwide are all recognized to impact client drug administration (Santomauro et al., 2021, p. 449). Other causes include technological advancements and quality-improvement programs. Patient safety is becoming more important, especially regarding medication therapies and high-alert drugs like unfractionated heparin (UFH). Specific UFH administration treatments can improve patient care management. Nurses are generally in a good position to spot pharmaceutical errors because they are on the front lines of patient care. On the other hand, nurses must work closely with other healthcare providers to achieve their goals.

The nurses should countercheck the medication dosage and administer them in the correct dosage. The nurses may prepare the heparin with different strengths wrongly, thus resulting in various errors. In addition, the preparation and administration of heparin differ in different types of heparin strengths. The errors also occur due to storage of heparin with different strengths in one place, poor documentation of the prescribed heparin in the ED, lack of individual/ independent double-checking of the heparin administration dosage, and incorrect programming of the infusion pumps (Gray, 2018, p. 369). These errors often occur among the nursing staff. Therefore, nurses should consistently check and document the heparin before administering it to the client. They should also independently double-check the heparin to prevent medication dose calculation errors. They should also ensure that the infusion pumps are correctly programmed to prevent over coagulation of the client’s blood.

Research purpose

The purpose of this research is to evaluate the causes of heparin drip administration errors and the ways through which these errors can be reduced. The heparin drips administration errors are very common and result in serious complications, at times, death of the clients. Despite the improvement in the majority of the errors that occur with heparin administration, such as the wrong client, several other errors have occurred with the administration of the heparin medication. 2.01 errors occur in 1000 heparin doses charged. The errors occur due to the incorrect handling of the heparin medication by different hospital personnel, such as pharmacists and physicians; however, most of the errors often occur from the nursing staff (Litman, 2018, p. 439). Therefore, the research paper aims to determine the causes of these errors and how to prevent them from occurring.

Research Questions

The research purposes to answer the following research questions;

1. What is the prevalence of heparin drips administration errors?

2. What are the factors associated with heparin drip administration errors?

3. How can heparin drip administration errors be prevented?

Conclusion

Intravenous heparin is used in the prevention of thrombosis in various clinical settings. It is considered a high-risk medication used in inpatient settings, commonly critical care units. The variation in the heparin administration protocols contributes to the majority of the drug errors associated with serious complications and mortalities. Some of these causes include drug dose calculation and preparation errors. Some of the prevention of heparin drip infusion errors include independent double-checking of the medication dose and preparation, correct programming of the infusion pumps, and clear documentation of the administered heparin dosage. However, there is a need to find out more about errors associated with heparin administration, their causes, and prevention to reduce the complications that occur with the errors.

References

Gray, G. (2018). Commentary: Improving Care through Innovations in Infusion Systems. Biomedical Instrumentation & Technology, 52(5), 366-371.

https://pdf.manuscriptpro.com/search/Abstract~30260667/1/cda77bb7/Commentary:-Improving-Care-through-Innovations-in-Infusion-Systems.

Lee, M. H., & Riley, W. (2021). Factors associated with errors in the heparin dose-response test: recommendations to improve individualized heparin management in cardiopulmonary bypass. Perfusion, 36(5), 513-523.https://pubmed.ncbi.nlm.nih.gov/32909506/

Litman, R. S. (2018). How do we prevent medication errors in the operating room? Take away the human factor. British Journal of Anaesthesia, 120(3), 438-440. https://pubmed.ncbi.nlm.nih.gov/29452799/

Santomauro, C., Powell, M., Davis, C., Liu, D., Aitken, L. M., & Sanderson, P. (2021). Interruptions to intensive care nurses and clinical errors and procedural failures: A controlled study of causal connection. Journal of Patient Safety, 17(8), e1433-e1440. 441-461. https://pubmed.ncbi.nlm.nih.gov/30113425/

Treiber, L. A., & Jones, J. H. (2018). Making an infusion error. Journal of Infusion Nursing, 41(3), 156-163.
https://pubmed.ncbi.nlm.nih.gov/29659462/

Warnock, L. B., & Huang, D. (2019). Heparin. https://pubmed.ncbi.nlm.nih.gov/30855835/

HOW TO REDUCE HEPARIN DRIPS ADMINISTRATION ERRORS 2

How to Reduce Heparin Drips Administration Errors

Phase Two

Lianet Aroche

Florida National University

Nursing Research

Nora Hernandez-Pupo

06/10/2022

Prevalence of heparin drip errors

A heparin drip error occurs when the incorrect dose of heparin is administered to a patient, which can have disastrous results, resulting in severe bleeding or even death. Blood thinners account for about 7% of all prescription errors in hospitalized patients (Johnson et al., 2018). Medication mistakes are common and are connected with higher patient morbidity and mortality (Panagioti et al., 2019). Every year, 7000–9000 individuals die due to medical errors (MEs) in the United States alone. 19% of MEs in the ICU are life-threatening, and 42% are significant enough or clinically significant to necessitate different life-sustaining therapy (Al-ani et al., 2020). A study showed that 1 of every 12 reported errors (8.3%) were anticoagulant errors (Dreijer et al., 2019). Anticoagulants were commonly involved in prescription error reports.

The percentage of nurses who report drug errors is 57.4% (Jember et al., 2018). Most parenteral drug faults are discovered during administration, with a rate of 32.1 percent versus 8.65 percent during preparation (Sutherland et al., 2020). Between December 2012 and May 2015, 42 962 pharmaceutical mistakes occurred. (87%) of these errors were caused by hospitals, whereas (13%) were caused by primary care. Anticoagulant prescription errors were detected in 8.3 percent of the reports, with hospitals reporting 96 percent. Low molecular weight heparins [LMWHs] were the most frequently reported drug classes (56.2%). Heparins accounted for 6.8% of the total (Sutherland et al., 2020). Despite the proportion of heparin drug infusion errors, several steps can be implemented to reduce the risks and incidences.

Factors associated with heparin drip administration errors

Heparin administration errors can have a variety of causes. One cause could be the complicated dose and delivery protocol for heparin infusions. Heparin is a strong anticoagulant, and administering heparin drips requires careful titration to get the optimal degree of therapeutic effect. Human error was the most common cause of anticoagulant drug mistakes (53.4%). Competence deficit (23.5%), failing to observe standard protocols (12.5%), and failure to double-check dosage were the most commonly occurring factors (12.2%) (Dreijer et al., 2019).

Furthermore, errors in the management of medicinal heparin infusion were attributed to the absence of communication and a recall slip during the nursing handoff communication. The procedure of obtaining blood was also influenced (Johnson et al., 2018). The most prevalent error was incorrect medicine, followed by an inaccurate dose, an inappropriate administration method, and an incorrect rate (Al-ani et al., 2020). Heparin drugs are more likely than others to cause serious harm due to the complicated doses, poor monitoring, and unequal adherence to treatment.

Factors include incorrect setting or value into the infusion pump interface, incorrect order, transcription, or preparation of medication, failure to correctly connect or clamp IV tubing, and patient intentionally or unintentionally adjusted pump programming increases the likelihood of drip error. Cooperation among professional members is another distinguishing feature contributing to infusion pump administration errors (Taylor et al., 2019). Also, recklessness due to weariness is another cause of heparin administration errors in various studies (Hee et al., 2019). Health care workers are affected by extreme working conditions, resulting in drug therapy errors.

Prevention of heparin drip administration errors

In detecting and preventing prescription mistakes, pharmacy technicians and pharmacists play an essential role (Maaskant et al., 2018). Heparin drips were better monitored by using frequent nursing shift updates. One of the specialized techniques identified in the current study for preventing medication errors was competent and experienced nurses, implying that trained and experienced nurses are better equipped (Jessurun et al., 2018). Determining the type of error and encouraging nurses to disclose errors is crucial (Hong, Hong, et al., 2019). It will assist in the evaluation of mistakes. As a result, providing an economic motivation for detected medical errors may assist healthcare facilities in reducing the number of heparin-related mistakes.

Among the most important preventive methods for preventing heparin drip mistakes are for nurses to act professionally. Studying pharmaceutical instructions, analyzing mistakes, nurses’ understanding of medication administration errors, jurisdictional difficulties, refresher courses on medication processes, and accuracy are all important aspects of clinical competence (Salar et al., 2020). Collaborative practice is necessary to ensure safe medication use and distribution. High-alert medications, particularly those with strict medical safety limitations, should be double-signed by doctors and nurses (Rodziewicz et al., 2022). All healthcare practitioners should collaborate to prescribe, administer, and monitor medications to reduce medication errors.

Nurses are more likely to make medication errors due to the increased pressures placed on them. Incidences must be detected, documented, and transformed into great experiences from which learning can be gained and utilized to enhance patient treatment procedures and methods. Nurses have been on the front layers of protection in identifying and disclosing drug errors thus far; these faults are substantially inadequately reported (Jember et al., 2018). It is important to ensure adequate staffing and proper shift allocation to minimize overwhelming situations in care delivery, resulting in medication errors.

Methodology

Introduction

This chapter explains the study’s design, geography, population, sampling techniques, and data collection methods, as well as how the data will be reviewed and presented after collection. It also contains details on the study’s ethical concerns.

Study Design

A descriptive, cross-sectional study design including quantitative data will be used in this investigation. Cross-sectional research is favored because it is rapid, saves time, is inexpensive to undertake, and is simpler to use.

Inclusion Criteria and Exclusion Criteria

Inclusion Criteria

The study will include respondents with suitable physical and mental health conditions, as determined by the respondents’ verbal testimonies and willingness to participate.

Exclusion Criteria

Participants who refuse to agree or display a lack of engagement in completing the responses by the studied sections or who submit copies of the questionnaire will be removed from the project.

Sampling Methods

A stratified sampling technique will be utilized to capture the sampled data equitably.

Data Collection Method

The respondent’s demographic details, as well as data on the distribution of heparin drip drug errors, factors associated with heparin drip errors, and preventative measures of heparin drip errors, will be gathered through a questionnaire. The questionnaire will be utilized after its accuracy and reliability have been confirmed. A panel of specialists will assess the questionnaire’s internal consistency. The participant will obtain consent after explaining the study’s details. Participants will be given instructions on how to complete the surveys, and after they are completed, the questionnaires will be returned to the researcher for evaluation and storage.

Data Analysis

Summary analysis with version 28 of the Statistical Package for Social Sciences will be used to evaluate quantitative data (SPSS). These findings will be discussed using tables, bar graphs, and pie charts. Frequency charts will be presented for binary categories, while mean scores will be provided for continuous data. The relationship between heparin drip delivery and parameters connected to heparin drug mistakes will be examined using chi-square statistics. The impact of various parameters on the proportion of heparin drip medication mistakes will be assessed using binary logistic regression analysis.

Ethical Considerations

The study’s procedure will be authorized by the hospital’s and school’s research ethics committees. Before being interviewed, consent will be sought from study participants after describing the research aim and objectives and ensuring the anonymity of the collected data. The information acquired from study participants will be treated with confidentiality to the greatest extent possible. The completed questions will be kept safe and secure in passcode spreadsheets.

Conceptual framework.

Factors associated with heparin drip administration errors

Running head: HOW TO REDUCE ERRORS WHEN ADMINISTERING HEPARIN DRIP? 1

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HOW TO REDUCE ERRORS WHEN ADMINISTERING HEPARIN DRIP?

Sample Paper

Abstract

This phase of the project is presenting the results of the project in numerical forms, using statistical tools to illustrate the final outcomes of the research project. It will be focusing in demonstrating the correlation between the Incidents Reports and the most common type of errors within the nursing staff, and the specific amount of nurses involved in the incidents.

The first table will give the information subdivided into four principal groups, so this time the analysis will be in base to the principal administration reason according to the principal diagnosis, from this table was created a representative graph that specify the attention in the relative frequency percent by administration reason.

The second table focuses the attention in the correlation between the Incident Reports, the numbers of nurses involved and the most common errors involving the medication administration. As part derivate was two different graphs to demonstrate the different aspects involving the incident that lead to the error. The first analysis that I can do from this table is from the most common errors involved in the incidents. The second analysis will be focus in the number of nurses involved by incident that makes a total of 17.

Introduction to the Results

This phase will have as goal to demonstrate the results of the research project, demonstrating the correlation between the Incidents Reports and the most common type of errors within the nursing staff, and the specific amount of nurses involved in the incidents. I will also be given the information in numerical forms to help responds the research question. It is crucial to take into the consideration when you give the results of the study do not prove the final answer. The findings help to illustrate the hypothesis supporting your study.

Table 1

Diagnosis for administration, numbers of incidents and relative frequency.

Note: The first table shows the results taken from the data collection from the Incident Reports, which was a total of 11 Incident Report in the past six months. The table illustrates the numbers of Incident Reports and the amount of incidents per administration reason; also the relative frequency in percent. The table gives us the information subdividing the information into four principal groups, so this time the analysis will be in base to the administration reason.

Relative Frequency by Diagnosis Reason

Figure 1: Graphic for relative frequency by administration reason. With these numbers we can see the relative frequency. In Figure 1 demonstrates the highest 46 percent was from the reports that involved the patients receiving the Heparin Drip for Strokes and TIAs.

It was a possible expected result since the majority of the patients admitted in this floor the diagnosis is for Strokes and TIAs. So the vulnerability will be higher in this type of population when the first line of medication management is the Heparin Drip. . The commonly use is because has a short biologic half-life in the body system about one to two hour, so it must to be order frequently or as continuous infusion. Safe and effective mechanisms need to be use in order to reduce the increasing medical-error of this high-risk medication.

Table 2

Most common errors, No. of incident and nurses involved.

Note: This second table will subdivide the results based on the Incident Reports, the numbers of nurses involved and the most common errors involving the medication administration.

From this table we can create two different graphs to demonstrate the different aspects involving the incident that lead to the error. The first analysis that I can do from this table is from the most common errors involved in the incidents. The second analysis will be focus in the number of nurses involved by incident that makes a total of 17 nurses that were interview with specifics questions to help support the research study. These questions can help us to identify the contributor’s factors that lead to the problem.

Most Common Errors

Figure 2: The graph demonstrates that between the most common errors Bag Replacement and Wrong weight have the highest incidents so we need to focus our attention in those to found out a solution and give one answer to our research question.

No. of Nurses involved related to the most common errors.

Figure 3: The pie graph was also created from the previous table 2 information shows the No. of nurses related to the most common errors. The highest incident of 6 nurses is related to the Wrong weight, so next step to correct will be pay attention in the first phase of the Protocol Initiation when the nurses are starting the Drip; analyze how the nurses are weighting the patients and the frequency to recheck it. When we talk about weight control special attention needs the patient with history of Congestive Heart Failure and End stage of Renal Diseases requiring Dialysis, the weight of patient change more often than the normal person.

Conclusions

Quantifying the amount of incident reports on the road to the most common errors in the floor involves the integration of the staff. For this investigation, one quantifiable research question was indicated to find out how to reduce errors when administrating Heparin Drip. The findings help to illustrate the hypothesis supporting your study.

In Figure 1 demonstrates the highest 46 percent was from the reports that involved the patients receiving the Heparin Drip for Strokes and TIAs. It was a possible expected result since the majority of the patients admitted in this floor the diagnosis is for Strokes and TIAs. So the vulnerability will be higher in this type of population when the first line of medication management is the Heparin Drip.

In Figure 2 establishes that between the most common errors Bag Replacement and Wrong weight have the highest incidents so we need to focus our attention in those to found out a solution and give one answer to our research question.

In Figure 3 the highest incident of 6 nurses is related to the Wrong weight, so next step to correct will be pay attention in the first phase of the Protocol Initiation when the nurses are starting the Drip; analyze how the nurses are weighting the patients and the frequency to recheck it.

References

Brennan TA, Leape LL, Laird NM. et al. (1991). Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. Pages: 324(6):370–6. 

Thomas EJ, Studdert DM, Burstin HR. et al. (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. Pages:  38(3):261–71. 

TK Gandhi, DL Seder, DW Bates. (2000). Methodology matters. Identifying drug safety issues: from research to practice. International Journal for Quality in Health Care. Vol. 12, Pages 69-76, https://doi.org/10.1093/intqhc/12.1.69

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.

Wrong weight Aptt out of time Adiministration line Transfer patient 0.46 0.09 0.18 0.27

Diagnosis Reason

Wrong weight Aptt out of time Administration line Tranfer patient Bag replacement 3 2 2 1 3

No. of Incident Report

Wrong weight Aptt out of time Adiministration line Transfer patient Bag Replacement 6 4 2 2 3

Phase 4- Feedback:

very good utilization of charts and graphs- good explanation of data findings.

outstanding job in the graphs and with the explanations- however, there are a few gaps between your participant size and those who participated in the study- please make sure you clearly identify your total numbers.

inclusion/exclusion criteria is missing- this too can be a limitation- setting- and the type of instrument used are also forms of limitations- this was covered in your readings.

One reference is NOT enough- 5 minimum is required for all phases.