Expectations of Independent Double Check - Heparin Drip

Transcription

1 Expectations of Independent Double Check - Heparin Drip A nurse asks you to double check the heparin drip they are administering Most recent PTT value. Heparin dose (bolus and continuous infusion rate) based on the physician order and PTT value. [see nomogram in Order text in the MAR ] Opens the patient s MAR in EPIC Verifies 5 rights including patient identification by verification of the name and medical record Scans the patient s arm band. Verifies that the medication line is labeled nearest the port closest to the patient with the name of the infusing drug. Traces line including: bag, pump and connection to patient. Programs the Alaris IV infusion pump using the correct profile (library) and Guardrails medication setting. Ensure correct therapy/intensity is chosen (e.g. High Intensity) and correct weight entered. Verifies the patient s MAR in EPIC. Verifies 5 rights including patient identification by verification of the name and medical record Verifies that the medication line is labeled nearest the port closest to the patient with the name of the infusing drug. Traces line including: bag, pump and connection to patient. Verifies the programming of the Alaris IV infusion pump using the correct profile and Guardrails medication setting. Ensure correct therapy is chosen (e.g. High Intensity for patients >125kg) and correct weight entered (*weigh patient as soon after admission as possible. Change the dosing weight **ONLY IF it will change the intensity (greater than or less than 125 Kg)**. Starts bolus and or infusion. 3. Both nurses sign on the MAR (first nurse accepts & second nurse verifies). 4. Independent Double check must also be verified and co-signed on the MAR whenever a medication bag is replaced, the dose or rate is changed or when an infusion pump is replaced (e.g. due to malfunction). 5. Staff nurses will review the heparin regimen including Guardrails setting during handoff communication with the oncoming nurse at the beginning of each shift, upon transfer from another unit and upon patient assessment (no signatures in the medical record required). 1

2 Expectations of Independent Double Check Heparin Drip- Adjustment to Infusion A nurse asks you to double check the heparin drip they are administering Most recent PTT value. Heparin dose (algorithm for adjusting continuous infusion rate) based on the physician order and PTT value. Opens the patient s MAR in EPIC Verifies 5 rights including patient identification by verification of the name and medical record Scans the patient s arm band. Verifies that the medication line is labeled with the name of the infusing drug. Reviews the nomogram to determine if: o The continuous rate needs to continue or be stopped o The patient needs a bolus dose or not Programs the Alaris IV infusion pump using the correct profile and Guardrails medication setting. Ensure correct therapy is chosen (e.g. High Intensity for patients >125kg) and correct weight entered. *Once therapy has been started, do not change the dosing weight in the Alaris IV pump*. Accepts the transaction in the MAR Verifies the patient s MAR in EPIC. Verifies 5 rights including patient identification by verification of the name and medical record Verifies that the medication line is labeled with the name of the infusing drug. Verifies the programming of the Alaris IV infusion pump using the correct nomogram and if: o The continuous rate needs to continue or be stopped o The patient needs a bolus dose or not Starts, stops or adjusts infusion, based on the nomogram and PTT. Times the draw of the next PTT. 3. Both nurses sign on the MAR in the medical record (Requesting RN accepts & verifying nurse verifies ). 4. Independent Double check must also be verified and co-signed on the MAR whenever a medication bag is replaced, the dose or rate is changed or when an infusion pump is replaced (e.g. due to malfunction). 5. Staff nurses will review the heparin regimen including Guardrails setting during handoff communication with the oncoming nurse at the beginning of each shift, upon transfer from another unit and upon patient assessment (no signatures in the medical record required). 2

3 Expectations of Independent Double Check Heparin Drip- New Bag A nurse asks you to double check the heparin drip they are administering Most recent PTT value. Heparin dose (nomogram for adjusting continuous infusion rate) based on the physician order and PTT value. Opens the patient s MAR in EPIC Verifies 5 rights including patient identification by verification of the name and medical record Scans the patient s arm band. Verifies that the medication line is labeled with the name of the infusing drug. Reviews the order, the PTT value and last MAR action to validate correct setting Reviews the order detail in the MAR Verifies 5 rights including patient identification by verification of the name and medical record Verifies that the medication line is labeled with the name of the infusing drug. Verifies the programming of the Alaris IV infusion pump using the correct nomogram and PTT. *Once therapy has been started, do not change the dosing weight in the Alaris IV pump*. Spikes the new bag, hangs the bag and ensures that the fluid is flowing, and double checks the pump settings. Restarts the pump at the same settings. Validates the time of the draw of the next PTT. 3. Both nurses sign on the MAR in the medical record. Requesting RN Accepts transaction in the MAR & verifying nurse Verifies the patient s MAR. 4. Independent Double check must also be verified and co-signed on the MAR whenever a medication bag is replaced, the dose or rate is changed or when an infusion pump is replaced (e.g. due to malfunction). 5. Staff nurses will review the heparin regimen including Guardrails setting during handoff communication with the oncoming nurse at the beginning of each shift, upon transfer from another unit and upon patient assessment (no signatures in the medical record required). 3

4 Expectations of Independent Double Check Heparin Drip- Handoff A nurse gives handoff report including the heparin drip they are administering Most recent PTT value Heparin dose (nomogram for adjusting continuous infusion rate) based on the physician order and PTT value. Opens the patient s MAR in EPIC Verifies 5 rights including patient identification by verification of the name and medical record Scans the patient s arm band. Verifies that the medication line is labeled with the name of the infusing drug at the connection nearest to the patient. Reviews the nomogram and lab value to ensure: o The continuous rate is currently set correctly Reviews the Alaris IV infusion pump using the correct profile and Guardrails medication setting. Ensure correct therapy is chosen (e.g. High Intensity for patients >125kg) and correct weight entered. *Once therapy has been started, do not change the dosing weight in the Alaris IV pump*. Verifies the patient s MAR in EPIC. Verifies 5 rights including patient identification by verification of the name and medical record Verifies that the medication line is labeled with the name of the infusing drug. Verifies the programming of the Alaris IV infusion pump using the correct algorithm and if: o That the pump is set at the correct rate according to the order and the latest PTT. 4

5 How to find PTT results in EPIC 1. Results review is the place to go to check on results of testss at any time. You can look there to review labs, cultures, radiology and cardiology results of exams. 2. While in the MAR, click Running Infusions. When you get to the Heparin Infusion, click on the summary sentence in blue: Summary sentence 5

6 Scrolling down on the next screen, you will see the last 3 results 3. Use the Anticoag report in Patient Summary: 4. Using order review, Active Medications will also give the detail of the order and at the bottom will be the latest labs (the same look as at the bottom of the order text in the MAR). 6