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• W1519920797 abstract "ABSTRACT Background: Titration protocols have been developed for anticoagulant medications, with the aim of reducing the time to therapeutic anticoagulation and increasing the time spent in the therapeutic range. Objectives: To evaluate compliance with a heparin titration protocol in patients presenting with acute coronary syndromes. Two secondary objectives were to evaluate the time required to reach therapeutic activated partial thromboplastin time (aPTT) and the time spent in the therapeutic range. Methods: The medical records of 170 consecutive patients with cardiac disease admitted to the coronary care unit over a 5-month period and requiring heparin therapy were reviewed. These patients received a total of 190 courses of therapy. Information about patients’ baseline characteristics, along with data related to their therapy and aPTT monitoring, were extracted for analysis. Results: Most of the 190 courses of therapy (133 or 70%) were for patients admitted with non-ST-elevation acute coronary syndromes. Therapeutic aPTT was reached in 21 ± 18 h (mean ± standard deviation), and aPTT remained in the therapeutic range for 63% of the time, on average. Of 587 interventions to adjust the rate of heparin infusion, 96 (16%) were not compliant with the protocol; 94 (49%) of the 190 courses of therapy were therefore subject to at least one noncompliant dosing adjustment. Of the 69 noncompliant modifications performed by nursing personnel, 32 (46%) involved miscalculations or misreading of the protocol and 16 (23%) involved a required dosage change that was not done. Of the 27 noncompliant adjustments performed by physicians, 12 (44%) involved reinitiation of heparin infusion at an inadequate rate. Conclusions: In using a heparin titration protocol to guide treatment of patients with acute coronary syndromes, physicians and nursing personnel performed many noncompliant dosing adjustments. These noncompliant adjustments were for the most part related to miscalculations of doses and misreading of the protocol.  RESUME Historique : On a mis au point des protocoles d’ajustement posologique des anticoagulants dans le but de reduire le delai d’obtention d’une anticoagulation therapeutique et d’accroitre le temps passe dans l’ecart therapeutique. Objectifs : Evaluer le degre d’adhesion au protocole d’ajustement posologique de l’heparine chez les patients presentant un syndrome coronarien aigu. Deux autres objectifs secondaires etaient d’evaluer le temps necessaire pour atteindre un temps de prothrombine partiel active (aPTT) therapeutique et le temps passe dans l’ecart therapeutique. Methodes : Les dossiers medicaux de 170 patients atteints d’une coronaropathie admis consecutivement a l’unite de soins coronariens sur une periode de cinq mois et necessitant une heparinotherapie ont ete examines. Ces patients ont recu un total de 190 traitements a l’heparine. Les renseignements relatifs aux caracteristiques de base des patients, ainsi que les donnees concernant leur therapie et le monitorage de l’aPTT ont ete obtenus pour fin d’analyse. Resultats : La plupart des traitements a l’heparine (133/190 ou 70 %) ont ete administres aux patients presentant un syndrome coronarien aigu sans elevation du segment ST. L’aPTT therapeutique a ete atteint en 21 ± 18 heures (moyenne ± ecart type) et l’aPTT s’est maintenu dans l’ecart therapeutique en moyenne 63 % du temps. Des 587 interventions visant a ajuster la vitesse de perfusion de l’heparine, 96 (16 %) n’etaient pas conformes au protocole, et 94 (49 %) des 190 traitements a l’heparine ont fait l’objet d’au moins un ajustement posologique non conforme. Des 69 modifications non conformes effectuees par le personnel infirmier, 32 (46 %) etaient attribuables a de mauvais calculs ou a une mauvaise interpretation du protocole et 16 (23 %) impliquaient une modification posologique necessaire qui n’a pas ete faite. Des 27 ajustements non-conformes effectues par les medecins, 12 (44%) concernaient la reinstauration de la perfusion d’heparine a une vitesse inadequate. Conclusions : Dans le cadre de la prise en charge des patients presentant un syndrome coronarien aigu, les medecins et le personnel infirmier ont effectue de nombreux ajustements posologiques de l’heparine non conformes au protocole. Ces ajustements non conformes etaient la plupart du temps attribuables a de mauvais calculs ou a une mauvaise interpretation du protocole." @default.
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• W1519920797 date "2005-01-01" @default.
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• W1519920797 title "Evaluation of Physicians’ and Nurses’ Compliance with a Heparin Protocol for Acute Coronary Syndromes" @default.
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