2025 Southeastern Residency Conference

Title: Evaluation of a heparin calculator best practice alert (BPA) implementation at a multi-hospital health system 
Authors: Brittaney-Ann Simpson, Kirsten DiPiro, Ambra Hannah, Jerri Jenkins  
Objective: Describe the use of a heparin infusion calculator dose mismatch Best Practice Alert (BPA) within a health system  
Self Assessment Question:
Background: The electronic heparin calculator has demonstrated benefits in reducing medication errors by minimizing manual calculations in the hospital setting. At Wellstar Health System, heparin infusion initiation and maintenance follow a nurse-driven protocol.  This study evaluated the effectiveness of the heparin infusion calculator dose mismatch Best Practice Alert (BPA) in improving adherence to the heparin calculator and its impact on correct dosing and therapeutic efficacy.  
Methods: A multicenter retrospective chart review was conducted analyzing adult patients who received a heparin infusion 90 days before BPA implementation (May 24, 2023 to August 22, 2023) and 90 days after (October 1, 2023 to December 30, 2023).  Patients were included if they exceeded the maximum starting dose requiring a weight-based heparin infusion adjustment (weight >83.3 kg on low/neuro dose heparin and >125 kg on high dose heparin). Patients were excluded if the heparin infusion was initiated in a procedural area, ordered outside of the heparin order sets, restarted after interruption, or continued on Xa monitoring after receiving a direct oral anticoagulant within 72 hours of heparin initiation. Additionally, patients were excluded from therapeutic efficacy calculations and safety measures if the heparin infusion was less than 24 hours. The primary outcome was to evaluate the impact of the BPA on adherence to heparin calculator weight-based dosing on initiation of a heparin infusion. The secondary outcome evaluated the time to therapeutic heparin levels while safety outcomes assessed major and minor bleeding events. 
Results: A total of 212 patients were included in each study arm. Between both study groups, the majority of patients received low-dose heparin (82%), with acute coronary syndromes being the most common indication (41.7%). The BPA was triggered 33 times in the post-implementation cohort, with an acceptance rate of 84.8% (28 cases). Incorrect initial heparin rates were significantly lower in the post-BPA group at 2.5% (n=5) compared to 6.8% (n=13) in the pre-BPA group (P=0.008). For secondary outcomes, the mean time to achieve the second therapeutic level was similar between groups (27 hours; P=0.53). There was no statistically significant difference in major and minor bleeding events (P=1.0 and P=0.49, respectively).
Conclusions: Implementation of the heparin calculator BPA was associated with improved compliance with starting the correct infusion rate for patients that exceeded the max rate based on weight.  No correlation was observed between heparin calculator compliance and the time to therapeutic levels or bleeding events. Further studies are needed to assess the BPA’s impact on heparin infusion rate adjustments over time.