6894 Improving intravenous heparin prescribing practice on a paediatric intensive care unit

Objectives Intravenous unfractioned heparin (UFH) is a high-risk anti-coagulant frequently used for the treatment and prophylaxis of thromboembolic disease in Paediatric Intensive Care. Safe administration of UFH requires close therapeutic monitoring and dose optimisation to minimise risk from bleeding or undercoagulation. This multidisciplinary quality improvement project aimed to improve compliance with UFH prescription guidelines in a regional PICU and to improve consistency of documentation. Methods A baseline retrospective audit was performed of patients receiving intravenous UFH on PICU between 01/01/21 and 30/06/21. Patients were identified from the trust critical care electronic records. Patients receiving extracorporeal membrane oxygenation (ECMO) or haemofiltration were excluded. A new intravenous heparin e-prescription template was designed to record the indication, target APTR/anti-Xa levels, dose rate and timing for next coagulation sample. A nursing template was created to document levels and infusion rate changes. The system was revised upon updating the trust guideline to recommend anti-Xa as first-line monitoring in line with current best practice. Two 'snapshot' re-audits were performed between 01/01/23–31/01/23 and 01/06/23–30/06/23 respectively. Results There were 36 eligible patients identified for the baseline audit with an age range of 1d to 18 yrs. The most common indications were post-operative cardiac surgery (n=15), other cardiac indications (n=7), ischaemic stroke (n=3) and venous sinus thrombosis (n=3). Of the total eligible patients only 32 (89%) had the indication for heparin documented and only 24 (67%) had target APTR/anti-Xa level recorded. Of the 19 targeted infusions, 13 (68%) had APTR checked post all changes and only 5 (26%) had all rate changes correct as per protocol. Following the intervention, two 'snapshot' re-audits were performed across a 6-month period, with a total of 15 eligible patients aged 3d to 16y4m. Most common indications included post-operative cardiac surgery (n=6) and venous thrombus (n=3). All patients had a documented indication for UFH and target anti-Xa level. Anti-Xa was checked within 6 hours of starting the infusion in 5 of 6 patients during the first re-audit cycle, and 8 of 9 during the second cycle. All dose changes for targeted infusions were appropriate as per protocol or an alternative clearly documented clinical decision Conclusion This project demonstrates that introducing electronic templates can improve intravenous heparin prescribing practice and consistency of documentation in PICU. As trusts become increasingly 'paper free', this may be replicable for other medications requiring frequent therapeutic monitoring. Ongoing work is required to further improve compliance with anti-Xa monitoring guidelines.