NEW YORK NURSE: January 2008

Ask the experts

New heparin guidelines

Q.: When I worked in the hospital we had a very specific protocol for administering heparin to patients. Now I work in an ambulatory care setting and I heard that the Joint Commission came out with new heparin guidelines that take effect early this year and apply to all settings. How will this affect my current practice?

A.: One of the new Joint Commission 2008 National Patient Safety Goals aims to reduce the risk of patient harm associated with the use of anticoagulant therapy. It is applicable to hospitals, ambulatory care settings, office-based surgery settings, and home care and long term care organizations seeking accreditation or certification. Although organizations actually have until January 2009 to implement the goals and related requirements, the Joint Commission expects that processes are at least being pilot tested by July 1 of this year.

The primary requirements to comply with this goal include:

  1. Each organization will have a defined anticoagulant management program that can be individualized for each patient undergoing therapy.
  2. The organization uses only oral unit dose products and pre-mixed infusions.
  3. The organization uses approved protocols for the initiation and maintenance of anticoagulant therapy.
  4. The organization has a policy for baseline and ongoing laboratory tests appropriate for safe monitoring of patients receiving any form of anticoagulant therapy, such as international normalized ratio (INR) values for patients receiving warfarin (Coumadin).
  5. Programmable infusion pumps are to be used for all patients receiving heparin intravenously.
  6. The organization provides education for prescribers, staff, patients, and families, which includes the importance of follow-up monitoring, compliance issues, dietary restrictions, and potential for adverse drug reactions and interactions.

As with all medication administration, RNs are expected to be knowledgeable of the use of the medication, customary dosage, contraindications, and potential side effects or complications. In addition, please remember that according to the State Board for Nursing, a patient-specific order from an authorized prescriber is required any time anticoagulant therapy is indicated, regardless of standing protocols that may be in place at any particular organization.

This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA Nursing Representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.