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Based on record review and interview, the hospital failed to ensure that medications were administered in accordance with physicians' orders. Patient 221 was not administered heparin (a blood thinner) for stroke management in accordance with the physician ' s titration order.

Findings:

A review of Patient 221's electronic clinical record with Pharmacist 11 showed that the patient was admitted to the hospital on 6/21/12 for acute cerebrovascular accident (stroke) with presentation of severe headache and left sided weakness and numbness. Intravenous (into the vein) heparin (a blood thinner) was ordered at 3:55 a.m. on 6/21/12 as follow:

Intravenous Heparin:

Start at 840 units per hour. Titration instructions below:

PTT <35 seconds: Increase by 200 units per hour
PTT 35 to 75 seconds: Increase by 100 units per hour. Give bolus dose 2000 units
PTT 76 to 115 seconds: No change
PTT 131 to 150 seconds: Hold infusion for 1 hour, then reduce rate by 200 units per hour
PTT above 150 seconds: Stop heparin infusion. Resume saline lock. Call MD for orders

Partial Thromboplastin Time (PTT) is a laboratory test used to monitor the effect of heparin. Heparin is a drug that is given intravenously (IV) or by injection to prevent and to treat thromboemboli (blood clots). When heparin is administered for therapeutic purposes, it must be closely monitored to minimize any adverse outcomes as a result of over or under anticoagulation (thinning of blood).

A review of Patient 221 ' s laboratory records showed a reported PTT of 67.8 seconds at 7:00 p.m. on 6/21/12. According to the physician order, Patient 221's therapeutic or goal PTT should be 76 to 115 seconds. A PTT result of 67.8 should warrant a bolus dose of heparin 2000 units and an increase in heparin infusion rate by 100 units per hour.

A review of Patient 221's electronic medication administration record (eMAR) showed that no bolus heparin dose was administered to the patient after the reported PTT of 67.8 seconds at 7:00p.m. on 6/21/12. A subsequent PTT result reported at 12:10 a.m. on 6/22/12 showed continued under-anticoagulation with a PTT result of 57.2 seconds. There was no documented clinical rationale for the withholding of the heparin bolus dose. The failure of the hospital to administer heparin to Patient 221 in accordance with the physician's order had resulted in prolonged under-anticoagulation which had the potential
to cause worsening stroke symptoms and poor stroke prognosis.

Based on record review and interview, the hospital failed to ensure that medications were administered in accordance with physicians' orders. Patient 221 was not administered heparin (a blood thinner) for stroke management in accordance with the physician ' s titration order.

Findings:

A review of Patient 221's electronic clinical record with Pharmacist 11 showed that the patient was admitted to the hospital on 6/21/12 for acute cerebrovascular accident (stroke) with presentation of severe headache and left sided weakness and numbness. Intravenous (into the vein) heparin (a blood thinner) was ordered at 3:55 a.m. on 6/21/12 as follow:

Intravenous Heparin:

Start at 840 units per hour. Titration instructions below:

PTT <35 seconds: Increase by 200 units per hour
PTT 35 to 75 seconds: Increase by 100 units per hour. Give bolus dose 2000 units
PTT 76 to 115 seconds: No change
PTT 131 to 150 seconds: Hold infusion for 1 hour, then reduce rate by 200 units per hour
PTT above 150 seconds: Stop heparin infusion. Resume saline lock. Call MD for orders

Partial Thromboplastin Time (PTT) is a laboratory test used to monitor the effect of heparin. Heparin is a drug that is given intravenously (IV) or by injection to prevent and to treat thromboemboli (blood clots). When heparin is administered for therapeutic purposes, it must be closely monitored to minimize any adverse outcomes as a result of over or under anticoagulation (thinning of blood).

A review of Patient 221 ' s laboratory records showed a reported PTT of 67.8 seconds at 7:00 p.m. on 6/21/12. According to the physician order, Patient 221's therapeutic or goal PTT should be 76 to 115 seconds. A PTT result of 67.8 should warrant a bolus dose of heparin 2000 units and an increase in heparin infusion rate by 100 units per hour.

A review of Patient 221's electronic medication administration record (eMAR) showed that no bolus heparin dose was administered to the patient after the reported PTT of 67.8 seconds at 7:00p.m. on 6/21/12. A subsequent PTT result reported at 12:10 a.m. on 6/22/12 showed continued under-anticoagulation with a PTT result of 57.2 seconds. There was no documented clinical rationale for the withholding of the heparin bolus dose. The failure of the hospital to administer heparin to Patient 221 in accordance with the physician's order had resulted in prolonged under-anticoagulation which had the potential
to cause worsening stroke symptoms and poor stroke prognosis.