PDHPPotential Designated Historic Property
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For consistency when comparing the PDHP and NDHP, the initiation time of the IV UFH was considered to be when the practitioner placed the order in the computer, not when the IV UFH infusion was started; it was not always possible to determine the true start time, particularly in the PDHP group.
Of 138 patients who met inclusion criteria, 52 and 86 patients respectively were maintained on the PDHP and NDHP.
Patients in the PDHP group had significantly higher serum creatinine (p=0.001) and lower hemoglobin (p=0.02) at initiation of the IV UFH compared to those in the NDHP group.
In addition, a significantly greater percentage of time was spent within therapeutic aPTT range in the NDHP group compared to the PDHP group (p<0.0001).
Over 22 months of PDHP use, 132 instances of subtherapeutic or supratherapeutic aPTT occurred without accompanying rate adjustments (mean 2.5 times per patient).
As the PDHP required a physician order for laboratory testing and infusion rate adjustments, the process logically would be faster if these steps were eliminated.
Minimal training on the PDHP was provided to the physicians, however.
During use of the PDHP, physicians occasionally commented on a single rate change in their daily progress notes; however, documentation was limited and the sequence of rate adjustments could not be tracked using physician documentation.
As the PDHP group had significantly higher serum creatinine and lower hemoglobin (markers often associated with more severe disease), this finding could be attributed to more acutely ill patients in the PDHP group.
This was not available for the PDHP so, for consistency, start time of IV UFH was considered the time the order was placed.
Findings of this study supported the transition of PDHP to NDHP as well as the growing awareness that greater nurse responsibility and involvement can promote positive outcomes.