2022 Quality Summit ePosters (Non-CE) - CathPCI Registry-24. A Standardized Approach to Heparin Management During Cardiac Catheterization [First Place ePoster Winner]

24. A Standardized Approach to Heparin Management During Cardiac Catheterization [First Place ePoster Winner]

Pdf Summary

A standardized approach to heparin management during cardiac catheterization was developed to prevent medication errors and adverse events related to anticoagulation. The approach was implemented by the multidisciplinary Cath Lab Quality committee. The goal was to maintain the activated clotting time (ACT) at less than 350 seconds during percutaneous coronary intervention (PCI) using heparin alone, with a target of less than 15% fallout. The implementation of the protocol significantly reduced the incidence of supratherapeutic anticoagulation, with the incidence of ACT greater than 350 seconds decreasing from 27% to 12.2% after the protocol was adopted. The Michigan BMC2 Cardiovascular Consortium performance measure of peak ACT greater than 350 seconds in less than 15% of patients was met in 8 out of 12 months in 2021. Factors associated with high ACT levels were reviewed by the Cath Lab Quality Committee, including protocol non-compliance, failure to account for prior IV heparin doses, failure to confirm accuracy by redrawing ACT levels, and drawing ACT levels too soon after heparin bolus. The standardized approach to heparin management has been shared across the Ascension Michigan cardiovascular service line. Future directions include evaluating the impact of ACT on major bleeding and major adverse cardiac events.

Keywords

heparin management

cardiac catheterization

medication errors

anticoagulation

activated clotting time

percutaneous coronary intervention

protocol implementation

supratherapeutic anticoagulation

Michigan BMC2 Cardiovascular Consortium

major bleeding