1301 / Heparin dose adjustment in patients with chronic renal failure

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Implemented
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Medication / IV Fluids
Deep venous thrombosis There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Improve the adjustment of the doses of heparin in the initial treatment of Emergency Department in patients with renal insufficiency in order to prevent bleeding complications.
Description of the Patient Safety Practice
 
Methods: In order to know if the treatment with heparin in patient with chronic renal failure is apprpiate, we review the prescribed treatment in the Emergency Department of the patients admitted in Internal Medicine and Cardiology. We have evaluated the cases with a with a value of creatinine (Cr) value higher than normal in the Emergency Room. After the improvement actions, another evaluation was made. For the evaluation of the adequacy of dose was considered the Summary of the heparin used in accordance with the Pharmacy Service. For the calculation of correct dose has been used formula Crockcroft and Gault considering the Cr. in Emergency, age, and weight in those cases consisting in the patient history or theoretical ideal weight of 70 kg . As improvement actions, in addition to briefings, the program has been introduced for calculating the creatinine clearance in Emergency computers and also we had a pharmaceutical presence in the morning, reviewing treatments. In adition, it was made an informative short video. To evaluate the differences between the results was used Chi-squared test. Results: Regarding the adjustment of doses of heparin, in 2011, to 32% of patients (confidence interval: 13.7 to 50.3%) were prescribed the wrong dose of heparin. In 2013, it dropped to 15.8% (CI 1.8 to 28.8%) and to 12.5% this year (ic0-28,2%).
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Not known
Level of implementation of reported practice
There is no specified text here
Specific and measurable outcome for the reported practice were defined
There is no specified text here
A baseline measurement before implementation of the reported practice was obtained
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A measurement after full implementation of the reported practice was obtained
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Evaluation of a "positive" effect of the reported practice on Patient Safety
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Type of before-and after evaluation
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Enclosure of a reference or attachment in case of published evaluation's results
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Health care context where the Patient Safety Practices was implemented
 
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Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Nurses
Pharmacists
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
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Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Public exposure
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Julian Alcaraz Martinez
Country: SPAIN
Organisation: Hospital Morales Meseguer. Murcia
E-mail: julian.alcaraz2@carm.es
Phone: 0034636047506
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