By Gloria Lau and Natalie Benninger
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Heparin is a high-alert medication with a heightened risk of significant patient harm when used in error. Heparin includes unfractionated heparin and low molecular weight heparin, both of which are anticoagulants used for prevention and treatment of blood clots. Ensuring safe and coordinated use of heparin is also a Required Organizational Practice of Accreditation Canada. A separate Required Organization Practice for High-Alert medications also addresses heparin use and management and you can read about it here.
Women’s College Hospital (WCH) promotes safety best practices when dispensing and administering unfractionated heparin and low molecular weight heparin through the implementation of safeguards that reduce the possibility of harm. Several WCH committees are involved in medication safety, including the Pharmacy & Therapeutics Committee which is responsible for identifying and mitigating risks associated with the medication system. Clinicians share this responsibility which includes reporting incidents through IRIS (Incident Reporting Information System). To minimize the risk of death or disabling injuries associated with heparin, heparin products are stocked in limited quantities in select areas of the hospital and safeguards are in place to minimize the likelihood of errors. Click here for the QTip.
Strategies that are employed for the safe use of heparin at WCH:
- Avoiding high concentrations of unfractionated heparin at WCH (the most concentrated product we stock is 10,000 units/1 mL vial) and it is not stocked in patient care areas
- Limiting the quantities of low molecular weight heparin stocked in patient care areas
- Restricting the patient care areas where low molecular weight heparins are stocked
- Standardizing medication options by having one low molecular weight heparin on our drug formulary – dalteparin
- Labelling all low molecular weight heparin products in patient care areas with visible warning and auxiliary labels that identify it as a high-alert medication
- Using pre-filled syringes for low molecular weight heparin (i.e., dalteparin) instead of multi-dose vials
- Providing training about high-alert medications such as heparin
- Requiring an independent double check for unfractionated heparin prior to administration
Heparin (100 units/mL, 3 mL syringe) is available for intravenous flushing of lines if an initial trial with normal saline flush is unsuccessful.
More information on the safe use of heparin can be found in the High-Alert Medication Management policy document.
To learn more about Accreditation, visit the Accreditation Intranet Hub.