title: Development and implementation of a comprehensive heparin-induced thrombocytopenia recognition and management protocol.
abstract: OBJECTIVE
  A quality initiative to improve the management of heparin-induced thrombocytopenia (HIT) at an academic medical center, including the development of guidelines on the use of direct thrombin inhibitors (DTIs), is described.
  
  
  CONCLUSIONS
  In keeping with the Joint Commission's National Patient Safety Goal (NPSG) for anticoagulant therapy (goal 03.05.01), a multidisciplinary working group conducted a needs assessment to identify areas for improvement in the center's HIT management practices, particularly the use of DTI therapy (an issue not specifically addressed by NPSG 03.05.01). The resulting action steps included (1) the implementation of a detailed protocol for the recognition and management of HIT, as well as guidelines on the use of the DTIs argatroban and lepirudin, (2) more efficient use and optimized documentation of initial and confirmatory tests in the electronic medical record (EMR), and (3) the education of pharmacists, nurses, and physicians on the use of the HIT protocol, with initial and ongoing case-based competency testing of pharmacy staff. Early postimplementation experience indicated that the protocol and associated activities have resulted in improved DTI prescribing and dosing, HIT documentation, and patient education practices while expanding pharmacists' involvement in ensuring optimal, cost-effective management of patients with HIT.
  
  
  CONCLUSIONS
  In one institution, an HIT working group extended the scope of NPSG 03.05.01 to include the parenteral DTIs. The implementation of the HIT protocol has resulted in greater compliance with appropriate DTI dosing and improved EMR documentation of HIT.
authors.affiliation: Department of Pharmaceutical Services, Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA. msmythe@beaumont.edu
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smythe
authors.forename: Trupti P
authors.initials: TP
authors.lastname: Mehta
authors.forename: John M
authors.initials: JM
authors.lastname: Koerber
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Forsyth
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sykes
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Corbets
authors.forename: Susan M
authors.initials: SM
authors.lastname: Melendy
authors.forename: Rajul
authors.initials: R
authors.lastname: Parikh
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000925:Anticoagulants / Q000009:adverse effects*; D000991:Antithrombins / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D010353:Patient Education as Topic; D010595:Pharmacists / Q000458:organization & administration; D010875:Pipecolic Acids / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy; D014481:United States
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban; C083544:lepirudin