Web-based Heparin Management System
Thrombotic disorders (myocardial infarction, unstable angina, stroke, deep venous thrombosis, pulmonary embolism) are among the most common reasons for hospital admission. (1) Anticoagulation plays an important role in the management of these illnesses. Although low molecular weight heparins are playing an increasingly important role in the management of thrombotic disease, the longer half-life, increased cost and renal elimination oflow molecular weight heparins limit their application in many patients with thrombosis. Therefore, unfractionated heparin is likely to continue to be used extensively in the inpatient environment. Heparin is a potent antithrombotic drug. However, by virtue of its pharmacology (a narrow therapeutic range and significant inter- and intra-individual variation in dosage requirements), heparin requires careful monitoring. Excessive concentrations of heparin increase the risk of bleeding while inadequate doses provide insufficient protection against recurrent thrombosis. (2-4) Consequently, weight-based heparin dosing nomograms have been developed, which have been demonstrated to result in significantly improved performance in achieving therapeutic concentrations of heparin compared with empiric dosing schedules. (5,6) Description (Set) JHU researchers have developed a web-based software program to manage heparin anticoagulation therapy. The program provides users with a continually updated hospital census by floor/room to ease patient selection. To preclude confusion in patient identification, subject demographic information including age and birth date are included. Heparin dose selection is automated such that users need only enter the patients weight and the desired aPTT target range. The order initiation screen also provides baseline hemoglobin, platelet count, serum creatinine, prothrombin time and activated thromboplastin time for reference to identify patients at higher risk for bleeding. Using evidence based, weight-based heparin nomograms developed for specific clinical indications (i.e. venous thromboembolism, unstable angina, etc.), the appropriate initial bolus and infusion doses are chosen and the order is transmitted by fax server to the pharmacy by the click of a mouse. Doses can be edited to suit the specific clinical situation. Using the heparin management web site, the nurse, after administering the heparin bolus and starting the infusion can schedule the first aPTT phlebotomy draw with a mouse click, which transmits the order to the central phlebotomy station by fax server. For each patient being monitored by the heparin management system, the system receives continuously updated laboratory reports so that it can contact the nurse caregiver for any patient on the system automatically by text-pager with laboratory results and recommended heparin dosage changes. This feature eliminates the most important cause of sub- and supra-therapeutic aPTT values for patients on heparin, the lag time between aPTT testing and clinician action in response to test results and allows immediate dosage changes without leaving the bedside. Once dose changes are made, the nurse/caregiver confirms the changes on the website which automatically orders the next aPTT lab draw at the appropriate time depending upon the lab result and necessary dose changes. Proposed Use (Set) This software could be incorporated easily into physician order entry software programs to improve management of heparin or other anticoagulants (or medications) that require lab monitoring.
Lehmann, Christoph U.
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