Policies and procedures

Consults, protocols, and therapeutic interchanges

System_RXCLIN 117 Pharmacy Procedure for Heparin Protocol

Key Points:

• Pharmacists will evaluate indication and current patient status and will optimize dosing and monitor labs “per policy”
• Titration calculations require two pharmacist signatures
• Pharmacists will order anti-Xa or PTT monitoring 6 hours after initiation and rate changes
• Pharmacists will document in Epic using i-Vents and consult notes with every rate change and at least daily

System_RXCLIN 113 Pharmacy Consult for Heparin Protocol ECMO

Key Points:

• Pharmacists will evaluate indication and current patient status and will optimize dosing and monitor labs “per policy”
• Titration calculations require two pharmacist signatures
• Pharmacists will order PTT monitoring 4 hours after initiation and rate changes
• Pharmacists will document in Epic using i-Vents and consult notes with every rate change and at least daily

System_RXCLIN 119 Pharmacy Consult for Heparin Protocol Impella

Key Points:

• Pharmacists will evaluate indication and current patient status and will optimize dosing and monitor labs “per policy”
• Titration calculations require two pharmacist signatures
• Pharmacists will order PTT monitoring 4 hours after initiation and rate changes
• Pharmacists will document in Epic using i-Vents and consult notes with every rate change and at least daily

System_RXCLIN 122 Pharmacy Consult for Heparin Protocol LVAD

Key Points:

• Pharmacists will evaluate indication and current patient status and will optimize dosing and monitor labs “per policy”
• Titration calculations require two pharmacist signatures
• Pharmacists will order PTT monitoring 6 hours after initiation and rate changes
• Pharmacists will document in Epic using i-Vents and consult notes with every rate change and at least daily

Additional information

Therapeutic anticoagulant transition guide 2019

• Micromedex
• UpToDate
• Lexicomp