Introduction: Heparin management remains complex due to challenges in dosing, monitoring variability, and lack of standardization across institutions. Literature supports nurse-managed protocols as safe and effective. Williams et al. demonstrated improved time to therapeutic range compared to provider-managed approaches. To maintain time to therapeutic range, optimize resource use, and enhance patient safety, a large community teaching hospital implemented and evaluated an interdisciplinary heparin protocol. Methods: A quasi-experimental, interrupted time series study was conducted in critical and progressive care cardiac units to evaluate the impact of an interdisciplinary heparin protocol. Patients with ventricular assist devices or receiving heparin outside of the study units were excluded. The intervention involved pharmacist initiation of continuous intravenous heparin, followed by nurse-managed titrations using a standardized protocol. This was compared to the existing pharmacist-driven protocol. Results: Ultimately, 342 patients were included with 138 patients in the pre-group and 204 in the post-group. Most were male, with a mean age of 67.4±12.9 years (pre) and 66.5±12.3 years (post). The primary indication for heparin was acute coronary syndrome without thrombolytics, followed by atrial fibrillation. No statistically significant differences were found in time to therapeutic range (14.9 hours vs. 14.3 hours; P =0.614), proportion of patients achieving therapeutic activated partial thromboplastin time (77.5% vs. 75.2%; P =0.698), or subtherapeutic (2 vs. 2; P =0.862) or supratherapeutic (1 vs. 1; P =0.828) values between the pre-intervention and post-intervention groups respectively. The interdisciplinary protocol was associated with a low rate of safety events. Conclusions: The interdisciplinary protocol maintained therapeutic outcomes and demonstrated a low rate of safety events. These findings support the feasibility of nurse-managed heparin titration within an interdisciplinary framework and suggest potential for improved resource utilization. Future integration of clinical decision support tools may further enhance safety and workflow efficiency.
Davis et al. (Sun,) studied this question.