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An occult finding in heparin drip order set.

Lucia Ponor1, Waseem Khaliq1, Rajanigandhi Hanumanthu1

  • 1a Department of Medicine Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore, MD, USA.

Hospital Practice (1995)
|September 23, 2015
PubMed
Summary

Including fecal occult blood tests (FOBT) in heparin drip order sets rarely changes management and is not evidence-based. Regular review of electronic medical record order sets is crucial for patient safety and quality care.

Keywords:
IV heparin dripOrder setselectronic medical recordsfecal occult blood testhospitalized patients

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Area of Science:

  • Healthcare quality improvement
  • Clinical informatics
  • Medical error reduction

Background:

  • The Institute of Medicine identified significant issues in the American healthcare system, including widespread medical errors.
  • Electronic Medical Records (EMR) and standardized order sets aim to reduce errors and clinical practice variation.
  • Non-standardized order sets can lead to inappropriate test ordering, such as fecal occult blood tests (FOBT) within heparin drip protocols.

Purpose of the Study:

  • To evaluate the clinical impact and consequences of including FOBT in the heparin drip order set.
  • To assess the frequency of FOBT ordering and the subsequent management changes when tests are positive.

Main Methods:

  • A retrospective study analyzed 898 adult patients receiving a heparin drip over six months at an academic center.
  • Focused analysis on 130 patients who underwent FOBT testing as part of the heparin drip order set.

Main Results:

  • 15% of patients on heparin drips had FOBT ordered; 25% of these were positive.
  • Positive FOBT results infrequently altered management (36% documented, 24% stopped heparin, 30% GI consult, 12% endoscopy).
  • A higher mortality rate was observed in patients with positive FOBT (15%) compared to negative (7%), p<0.05.

Conclusions:

  • Fecal occult blood testing within heparin drip order sets is infrequently performed and rarely impacts patient management.
  • The inclusion of FOBT in this specific order set is not evidence-based and warrants removal.
  • Continuous and rigorous review of all electronic order sets is essential to maintain clinical relevance and patient safety.