지속정맥주입 헤파린의 처방 및 투여 자동화 프로그램 적용을 통한 업무 개선 연구
Improvements for Continuous Intravenous Heparin Management Practice through Application of HOAP (Heparin Order & Administration Program)
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UFH (unfractionated heparin) has been classified as a high-alert medication by theInstitute for Safe Medication Practices due to its narrow therapeutic range and the risk of seriousadverse effects. To reduce medication errors, improve the patient safety, and simplify UFH relatedwork processes, we developed a UFH computerized system, HOAP (heparin order & administrationprogram). The aim of this study is to determine the safety and effectiveness of HOAP. The availabilityratio of HOAP went from 43% in Feb 2014 to 100% in June 2014. The HOAP reduced the number of steps required to order and administer heparin from 6 to 3 in physicians, and from 9 to 7 steps fornurses. A total of 167 patients were included in this study. Average run time of interventiondecreased significantly from 3-10 minutes to 1-3 minutes in physicians and nurses, respectively(physician: p=0.018, nurse: p=0.014). HOAP reduced the subjective run time per intervention by morethan 5 minutes. The HOAP reduced the prescription related errors from 5.7% to 0.1%, and reducedadministration related errors from 13.5% to 1.0% (p < 0.0001). The HOAP also decreased the timeinterval of the control infusion rate from 9.2 hrs to 5.9 hrs (p = 0.001), but there was no statisticallysignificant difference between the two groups in regards to reaching the target aPTT (42.1% vs39.0%). The difference in the mean bleeding scores was not statistically significant between pre andpost group. We concluded that HOAP is helpful in improving UFH related work processes, preventingmedication errors, and reducing the run time through standardization and automatization. Therefore,additional reserch is needed to demonstrate the clinical effectiveness of HOAP.
Abstract
UFH (unfractionated heparin) has been classified as a high-alert medication by theInstitute for Safe Medication Practices due to its narrow therapeutic range and the risk of seriousadverse effects. To reduce medication errors, improve the patient safety, and simplify UFH relatedwork processes, we developed a UFH computerized system, HOAP (heparin order & administrationprogram). The aim of this study is to determine the safety and effectiveness of HOAP. The availabilityratio of HOAP went from 43% in Feb 2014 to 100% in June 2014. The HOAP reduced the number of steps required to order and administer heparin from 6 to 3 in physicians, and from 9 to 7 steps fornurses. A total of 167 patients were included in this study. Average run time of interventiondecreased significantly from 3-10 minutes to 1-3 minutes in physicians and nurses, respectively(physician: p=0.018, nurse: p=0.014). HOAP reduced the subjective run time per intervention by morethan 5 minutes. The HOAP reduced the prescription related errors from 5.7% to 0.1%, and reducedadministration related errors from 13.5% to 1.0% (p < 0.0001). The HOAP also decreased the timeinterval of the control infusion rate from 9.2 hrs to 5.9 hrs (p = 0.001), but there was no statisticallysignificant difference between the two groups in regards to reaching the target aPTT (42.1% vs39.0%). The difference in the mean bleeding scores was not statistically significant between pre andpost group. We concluded that HOAP is helpful in improving UFH related work processes, preventingmedication errors, and reducing the run time through standardization and automatization. Therefore,additional reserch is needed to demonstrate the clinical effectiveness of HOAP.
참고문헌 (11)
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