title: An occult finding in heparin drip order set.
abstract: BACKGROUND
  In 1998, the Institute of Medicine (IOM) noted that the American healthcare system had many problems. A major concern was the pervasiveness of medical errors. Electronic medical records (EMR) were introduced for myriad of reasons, one being to reduce these errors. Within the EMR, order sets have been shown to reduce variation in clinical practice and improve the quality of care. However, the lack of standardization in these sets enables peculiar orders, such as fecal occult blood test (FOBT) in the heparin drip order set at our hospital, to be surprisingly included. Our study was conducted to evaluate the consequences associated with having FOBT in this order set.
  
  
  METHODS
  A retrospective study of 898 adult hospitalized patients over a 6-month period, who had a heparin drip ordered at a single academic center, was conducted. The main focus of our study was the 130 patients for whom the FOBT was sent.
  
  
  RESULTS
  Fifteen percent (n=130) of patients started on IV heparin had FOBT sent, of which 33 (25%) came back positive. Approximately one-third (36%) of the positive results were documented by a provider, either in a progress note or discharge summary. In eight instances of a positive FOBT (24%), the heparin drip was stopped. For 10 patients with a positive test (30%), gastroenterology was consulted, and 4 (12%) patients had inpatient endoscopy. Five patients with positive FOBT died while in the hospital (15%) as compared to seven patients (7%) in the negative FOBT group, p<0.05.
  
  
  CONCLUSIONS
  Most patients started on heparin did not have FOBT tested, and the results changed management infrequently, even when positive. The regular review of all order sets is imperative to ensure that they remain evidenced-based and sensible.
authors.affiliation: a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ponor
authors.affiliation: a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.
authors.forename: Waseem
authors.initials: W
authors.lastname: Khaliq
authors.affiliation: a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.
authors.forename: Rajanigandhi
authors.initials: R
authors.lastname: Hanumanthu
authors.affiliation: a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.affiliation: a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Wright
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D006493:Heparin
keywords: IV heparin drip; Order sets; electronic medical records; fecal occult blood test; hospitalized patients