Clinical Audit of Heparin Use in Rift Valley General Hospital, Nakuru County, Kenya

Background: Heparin is a high risk medicine that may cause significant harm if not used properly. It is ranked among the top 5 “high alert” medications by the Institute of Safe Medication Practices because of its low therapeutic index and potential for serious adverse outcomes. Adherence to guidelines and protocols, as well as careful monitoring of heparin use, is important in maximizing benefits of its use and minimizing on harm. Objective: The aim of this study was to examine the processes and outcomes of heparin use in adult in- patients at the Rift Valley General Hospital through the conduct of a clinical audit. Methodology: A structured clinical audit tool was developed through consolidation of information from various sources. The structures supporting heparin use were physically assessed, including the availability of policies, guidelines or protocols, protamine and laboratory reagents. The processes and outcomes of its use were audited through the prospective observation of heparin dosing, administration and monitoring among eligible adult in-patients. Results: Clinical audit revealed there were no policies, protocols or guidelines to guide heparin use at Rift Valley General Hospital. Delayed or lack of heparin monitoring were observed. Heparin termination was done well by introduction of warfarin at least three days before stopping heparin in majority of the patients. The overall clinical audit score at Rift Valley General Hospital was 60.6% which showed minimal compliance to the performance threshold/standard of heparin use. Conclusions: Clinical audit for heparin use in RVGH concluded inadequate compliance to the set standards. There is need to avail guidelines, protocols or policies in the institution and conduct regular monitoring to ensure use of heparin is improved and maximum benefit is realized.