Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia
Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia
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DOI：
10.1093/ajhp/zxaa342
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发表时间：
2021-01-01
影响因子：
2.7
通讯作者：
Kasthuri, Raj S.
中科院分区：
文献类型：
--
作者：
Northam, Kalynn A.;Chen, Sheh-Li;Kasthuri, Raj S.
目的。肝素诱导的血小板减少症(HIT)是肝素治疗的严重并发症。管理策略是复杂的，包括停止使用肝素产品，启动替代抗凝剂，解释实验室测试结果，记录肝素过敏，以及提供患者教育。在一家学术医疗中心进行的用药错误报告和回顾性审查揭示了质量改进倡议的机会，并导致了HIT管理的多学科工作流程的创建。在一项事前和事后研究中，评估了多学科工作流程对HIT安全和管理的影响。实施前组由2014年4月4日至2016年5月31日接受HIT疑似测试的成年患者组成；实施后组由2016年11月1日至2018年10月31日接受测试的成年患者组成。主要结果是在HIT测试进行期间使用肝素产品的发生率。次要结果是适当的肝素过敏记录的比率。在实施工作流程后，在HIT检测结果待定时服用肝素产品的发生率显著降低，从54.2%降至20.0%(P<；0.001)。适当的肝素过敏记录率从95.0%上升到100%(P<；0.001)。HIT管理的多学科工作流程的实施大大减少了正在进行检测时使用肝素的发生率，并提高了适当的肝素过敏记录的比率。
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.