Purpose: Heparin-induced thrombocytopenia (HIT) is a severe complication of heparin therapy. Diagnosis requires clinical evaluation and laboratory testing. The 4T score is a pretest clinical scoring system used to assess the probability of HIT. A non-profit community hospital implemented mandatory 4T score documentation prior to ordering PF4 tests for suspected HIT patients, following a pharmacy-driven approach to optimize the prescribing of argatroban. The purpose of this performance improvement project is to evaluate the implementation of 4T score documentation on PF4 testing and argatroban utilization.
Methods: In a retrospective, multi-site chart review study conducted, electronic records of patients were reviewed to assess the effects of 4T score documentation on PF4 testing orders. The study included adult patients who were admitted to one of the five practice sites between January 2020 and November 2022 and had a suspicion HIT with a PF4 test ordered. The primary outcomes assessed the number of PF4, and SRA tests ordered and the percentage of positive results for HIT annually. Secondary outcomes included the number of SRA orders and results, reporting of heparin allergy in patients with negative SRA results, time taken for SRA results, and the utilization of argatroban. Data collected from each patient's medical record included baseline demographics, SRA results, documentation of heparin allergy, initial anticoagulant prescribed, platelet trend, ordering provider, and argatroban utilization. The analysis involved using χ2 test and Fisher's exact test for the primary outcomes.
Results: A total of 42 patients with a positive PF4 test were included in the analysis Mandatory 4T score documentation significantly reduced PF4 orders by 68% over two years (p
Conclusion: Implementation of mandatory 4T score documentation significantly reduced PF4 orders and improved HIT diagnostic testing. Challenges remain in heparin allergy reporting and appropriate discontinuation of argatroban. The results of this project have demonstrated that standardized documentation is essential for optimizing HIT diagnosis and management protocols. Future efforts will focus on improving heparin allergy reporting practices and providing clear recommendations for discontinuing alternative anticoagulant therapy through a multi-disciplinary approach.
Florida Residency Conference
Ruiz, Maria A.; Justiz, Jessica; Gopalani, Radhan; Clarke, Heidi; and Dittmar, Erika, "Implementation of 4T score documentation on PF4 testing in patients with Suspected heparin induced thrombocytopenia (HIT)" (2023). All Publications. 4992.
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