Emergency department pharmacist impact on time to administration of heparin: a brief report

Abstract

In the United States, venous thromboembolisms (VTE) and acute coronary syndrome (ACS) are significant causes of morbidity and mortality. Anticoagulant medicines, such as heparin, are often indicated to stop or prevent clot formation, and early administration of heparin has been associated with reduced mortality. There is no literature evaluating whether administration of heparin is expedited when pharmacists are involved in patient care in the emergency department (ED). The purpose of this study was to determine whether the presence of an ED pharmacist decreased time to heparin administration for patients with VTE or ACS. This study was approved by the institutional review board at the Sisters of Charity of Leavenworth (SCL) Health Institutional Review Board (reference number: 2021-047). This retrospective cohort analysis evaluated patients who presented to the ED between 1 January 2019 and 30 May 2022 and received an order for unfractionated heparin with a confirmed diagnosis of VTE or ACS. The chi-square test and Wilcoxon ranked-sum test were used to detect differences between groups. A total of 65 patients were included in the analyses. Comparison of the median time between order and administration of heparin revealed that patients with an order placed while a pharmacist was present in the ED received heparin sooner than patients without an ED pharmacist present (32 min vs 50 min, p = 0.02). Time to administration of heparin was significantly shorter when a pharmacist was present in the ED at the time the order was placed by the care team. Findings suggest that the presence of an ED pharmacist expedites time to heparin administration.