Treatment of heparin-induced thrombocytopenia before and after the implementation of a hemostatic and antithrombotic stewardship program

Ritchie, Brianne M.; Sylvester, Katelyn W.; Reardon, David P.; Churchill, William; Berliner, Nancy; Connors, Jean M.

doi:10.1007/s11239-016-1408-6

Cited by 21 publications

(14 citation statements)

References 8 publications

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“…We suspect this reduction was due to improved communication among the healthcare team while testing was ongoing and close follow-up once testing was finalized. In contrast to the findings of Ritchie et al, 5 we were able to more effectively reduce heparin administration rates in patients undergoing HIT testing. Many of our interventions focused on identifying patients at the time orders for HIT testing were placed rather than when an alternative anticoagulant was ordered; this may have allowed us to recommend heparin discontinuation sooner in the Our study had a number of limitations to consider.…”

Section: Discussioncontrasting

confidence: 99%

“…Our results are consistent with previous literature that describes the impact of protocol implementation for patients undergoing HIT testing. Ritchie et al 5 published their experience with implementing a hemostatic and antithrombotic stewardship program. They described high rates of heparin administration (79.9%) in patients undergoing HIT testing.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The proportion of patients who continue to receive heparin with ongoing HIT testing is not well described. Ritchie et al 5 published their experience with implementing a hemostatic and antithrombotic stewardship program. In their pre-post study, they found high rates of continued heparin administration (79.9%) despite ongoing testing for HIT.…”

mentioning

confidence: 99%

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Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Northam

Chen

Stivers

et al. 2020

American Journal of Health-System Pharmacy

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Purpose Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin administration. Management strategies are complex and include discontinuing heparin products, initiating alternative anticoagulants, interpreting laboratory test results, documenting heparin allergies, and providing patient education. Medication error reports and a retrospective review conducted at an academic medical center revealed an opportunity for a quality improvement initiative and led to the creation of a multidisciplinary workflow for the management of HIT. In a pre-post study, the impact of the multidisciplinary workflow on the safety and management of HIT was evaluated. Methods The preimplementation group consisted of adult patients tested for suspected HIT from April 4, 2014, through May 31, 2016; the postimplementation group consisted of adult patients tested from November 1, 2016, through October 31, 2018. The primary outcome was the incidence of heparin product administration while HIT testing was ongoing. The secondary outcome was the rate of appropriate heparin allergy documentation. Results The incidence of heparin product administration while HIT testing results were pending was significantly reduced, from 54.2% to 20.0% (P < 0.001), after workflow implementation. The rate of appropriate heparin allergy documentation significantly increased, from 95.0% to 100% (P < 0.001). Conclusion Implementation of a multidisciplinary workflow for the management of HIT significantly reduced the incidence of heparin administration while testing was ongoing and improved the rate of appropriate heparin allergy documentation.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Northam

Chen

Stivers

et al. 2020

American Journal of Health-System Pharmacy

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“…3,13 Motivated by these factors and others, multiple published manuscripts now describe the development and implementation of more comprehensive Thrombosis and Hemostasis Management Programs (THMPs) and their significant impact on adverse event rates, clinical outcomes, and care-related costs. [14][15][16][17][18][19][20][21][22][23] General and specialty pharmacy residency programs have also contributed to the implementation of related services which have positively impacted patient care outcomes and generated significant return on investment (Table 3). 7,17,[23][24][25][26] From their roots in warfarin and heparin management for a limited number of indications (eg, atrial fibrillation, cardiac valves),…”

Section: Advance Education Comprehension and Competencymentioning

confidence: 99%

“…Clinical activities and responsibilities of the pharmacists in these anticoagulation stewardship programs go beyond that of the core residency training and are essential to better anticoagulation care. Therefore, there is a need to evaluate residency requirements and the concept of a new residency program dedicated to antithrombotic and hemostatic medications 14,19,20,32‐34 …”

Section: Evolution Of Brigham and Women's Hat Programmentioning

confidence: 99%

Creation of a novel specialty residency in thrombosis and hemostasis management

Inglis

Triller²,

Burnett

et al. 2022

J Am Coll Clin Pharm

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Antithrombotic and hemostatic medications are essential, yet high‐risk therapies commonly used for the prevention and treatment of thrombosis and bleeding. Since first demonstrating the ability to improve the safety and quality of heparin and warfarin‐related care many years ago, pharmacists now play an important expanded role in more comprehensive and complex thrombosis and hemostasis management programs. Such programs encompass the prevention and treatment of thrombosis and bleeding across care settings, medical indications, and professional services. These programs impact not only appropriate use of antithrombotic medications, but also of antidotes, blood products, medical devices, laboratory testing, and other important aspects of care. In addition to providing direct patient care, pharmacists are increasingly involved in the development and implementation of system‐level processes and quality improvement activities that require technical knowledge, leadership skills, and effective multidisciplinary collaboration. Evolution in health care regulation and accreditation standards, along with national efforts to advance the concept of Anticoagulation Stewardship, will likely accelerate the growth and expansion of thrombosis and hemostasis management programs, increasing the demand for well‐trained and experienced clinical pharmacists. However, none of the existing accredited specialty pharmacy residency programs encompasses the full range of skills and experiences necessary for new pharmacists to practice effectively in this complex and rapidly evolving field. This manuscript describes the evolution of the Hemostasis and Antithrombotic Stewardship program at Brigham and Women's Hospital and the development of a novel postgraduate year 2 (PGY2) pharmacy residency in this specialty area. It provides details of the new PGY2 residency program curriculum and puts forth a vision of success for such programs at the local and national levels.

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Securing administrative leadership commitment for anticoagulation stewardship programs

May,

Triller,

Inglis

et al. 2024

J Am Coll Clin Pharm

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Anticoagulation is a leading cause of medication‐related harm. As a result, there is increasing recognition of the importance of the development of anticoagulation stewardship programs to ensure safe and effective anticoagulation use across health care settings. Securing administrative leadership support to build such programs is a necessary first step but is often a significant barrier to implementation. Herein, we present a structured approach to guide providers advocating to leadership for stewardship programs at their institutions. We divide the approach into four phases: (1) Build the foundation, (2) Select stewardship initiatives, (3) Develop implementation plans, and (4) Prepare and present a business plan. Within each phase, we outline specific actions to consider, all leading up to the end goal of creating a compelling business plan to generate administrative leadership buy‐in. We also provide resources to promote the understanding of institutional needs as well as broader trends across health systems that influence stewardship program development. Our aim is to provide stewardship advocates with the tools to effectively secure leadership support to facilitate the development of Anticoagulation Stewardship Programs across all health care institutions.

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Treatment of heparin-induced thrombocytopenia before and after the implementation of a hemostatic and antithrombotic stewardship program

Cited by 21 publications

References 8 publications

Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Impact of a multidisciplinary workflow on safety and management of patients with heparin-induced thrombocytopenia

Creation of a novel specialty residency in thrombosis and hemostasis management

Securing administrative leadership commitment for anticoagulation stewardship programs

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