MADISON MEMORIAL HOSPITAL Version #: Version

Title: Heparin Protocol: DVT & PE

Process Owner: Kayla Burns, Justin Croft, Ashlie Gamero, Holly Johnson, Date Approved:
Olivia Moore, Karlie Nate

Approver(s): Sam Butikofer; Kevin McEwan Effective Date:

Department(s): ICU, Medical-Surgical, Emergency Room Next Review

Date:

(This document is confidential and proprietary to Madison Memorial Hospital. Unauthorized use or copying without written consent is strictly prohibited.)

Purpose/Summary:
Purpose
The purpose of this policy is to use heparin in the prevention and treatment of deep vein
thrombosis (DVT) and pulmonary embolism (PE) in a safe and effective manner.

Summary
Heparin is a medication that can be used to prevent and/or treat venous thromboembolism
(VTE). One issue that can put patients in danger is when too much heparin is given or when they
are on heparin for too long. Another contributing factor to heparin not being utilized correctly is
when staff members do not understand the usage of heparin and patients do not correctly
understand what heparin is and what they are on it for. This policy addresses these two concerns
and others by outlining staff training, patient education, administering heparin, prevention and
treatment of VTE, and how to assess patients before, during and after heparin administration.

Definitions:
● Venous thromboembolism (VTE): refers to a blood clot that originates in one’s veins
(American Heart Association, 2017).

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● Pulmonary embolism (PE): occurs when a DVT breaks free from its place of origin and
travels to the lungs and blocks some or all blood flow (American Heart Association,
2017).
● Deep vein thrombosis (DVT): is when blood clots in a deep vein, most commonly the
leg, but can also occur in the arm or other veins (American Heart Association, 2017).
● Heparin Induced thrombocytopenia (HIT): is an immune-mediated disorder that
causes antibodies to bind to platelet factor four and heparin causing thrombocytopenia
(Gowthami A., 2014).
● Thrombocytopenia: Thrombocytopenia...is a condition in which your blood has a lower
than a normal number of blood cell fragments called platelets (PLATE-lets)...When your
blood has too few platelets, mild to serious bleeding can occur. Bleeding can occur inside
your body (internal bleeding) or underneath your skin or from the surface of your skin
(external bleeding) (Thrombocytopenia, n.d.).
● Heparin: An anticoagulant (Yoost & Crawford, 2020).
● Anticoagulant: A medication that decreases fibrin formation, which prevents the
formation of blood clots (Yoost & Crawford, 2020).
● Activate partial thromboplastin time (aPTT): A laboratory value used to measure
appropriate levels of heparin (Lewis et al., 2017).
● Factor Xa Inhibitors: Medications that prevent the formation of factor Xa, which
prevents coagulation (Lewis et al., 2017).
● Anti-Xa test: Assay that measures antithrombin levels (Newall, 2013).
● Complete Blood Count (CBC): A test for diagnosis that includes a count of red blood
cells, a count of white blood cells, a differential white blood cell count, the hematocrit,
RBC indices, and level of hemoglobin (Yoost & Crawford, 2020).
● Obesity: A body mass index (BMI) of 30kg/m2 (Lewis et al., 2017).
● Body mass index (BMI): Weight in pounds multiplied by 703 and divided by height in
inches squared (Lewis et al., 2017).
● Adverse Reaction: a dangerous reaction by the body to the drug that is being used
(Lewis et al., 2017).

Goals and Objectives:

1. All healthcare personnel will be required to review this policy at least once annually and after

any adverse event related to heparin occurs.

2. Heparin will be safely administered.

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3. Patients and staff will be educated on the purpose of heparin and its side effects.

4. Patients and staff will be educated on the signs and symptoms of DVT and PE.

5. Patients will be monitored throughout the heparin administration.

Quality: The requirement for healthcare staff to review this policy on an annual basis, and after

any adverse event, will help the staff to consistently administer heparin in a safe and beneficial

way. It will help to remind them of the importance of these policies in providing high-quality

healthcare to their patients.

Providing the Exceptional Experience: Educating staff about how to properly care for patients

getting heparin will help them take better care of their patients. Educating patients about heparin

implications will empower them to take part in their own care plans and be their own advocates.

Following the administration protocol will serve to decrease mistakes and adverse events (such

as bleeding and VTEs), helping patients avoid these negative experiences while in the hospital.

Ensuring Our Future: Following this policy and the procedures therein will ensure that adverse

events pertaining to heparin administration will be decreased. This will protect the reputation and

credibility of this hospital for the future.

Equipment and Suitable Environment Needed:

● Heparin (Yoost & Crawford, 2020).
● Protamine sulfate (Pharmacology book)
● Alcohol swabs (Yoost & Crawford, 2020).
● 2x2 gauze pad (Yoost & Crawford, 2020).
● Adhesive bandage (Yoost & Crawford, 2020).
● Non-sterile gloves (Yoost & Crawford, 2020).
● Measuring tape (Eckhardt & Jarvis, 2020).
● Oxygen saturation monitor (Eckhardt & Jarvis, 2020).

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● Blood pressure monitor (Eckhardt & Jarvis, 2020).

● Lab for diagnostic testing (Yoost & Crawford, 2020).
● Vacuum blood vials (Elsevier, 2020).
● Saline syringes (Elsevier, 2020).
● Patient room (Yoost & Crawford, 2020).
● Locked storage area for the medication (Idaho Department of Health and Wealthfare,
2013)
● Compression Stockings (Joseph, et al., 2014).
● Sequential compression device (Joseph, et al., 2014).
● Syringe (Yoost & Crawford, 2020).
○ Subcutaneous
■ ½-3 ml
○ Intramuscular
■ Adults: 2-5 ml
■ Children: 0.5-1 ml
● Needle (Yoost & Crawford, 2020).
○ Subcutaneous:
■ ⅜-⅝ in., 25-31 gauge
○ Intramuscular:
■ Adults:1-3 in., 19-25 gauge
■ Children: ⅝-in., 25-27 gauge
● Doppler (Wells, Anderson, 2013).
● Wells Criteria Scale (Eckhardt & Jarvis, 2020).

Procedure 1: Staff Training

Overview Details Quality
Records
Staff Training Training to be attended by all healthcare workers,
physicians, and nurses, who prescribe, administer, and
monitor Heparin use.

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Step 1 What is heparin?

What? ● Definition of heparin.
● Heparin administration for DVT and PE:
Heparin is commonly administered to post-
operative patients. It is used to prevent blood
clots as well as treat them after they have
formed (Warnock & Huang, 2019).

Step 2 Why use heparin? Be familiar with the advantages and

Why? disadvantages of the use of Heparin in preventing and
treating PE and DVT.
● Advantages
○ Prevention of DVT and PE.
○ Easily reversible.
○ Makes blood thinner.
● Disadvantage
○ Increased risk for bleeding.
○ Frequent laboratory monitoring.
○ The cost associated with heparin therapy
(Maynard G, 2014).

Step 3 Who is a candidate for heparin administration?

Who? ● Patients who are at risk for or are currently
suffering from pulmonary embolisms and deep
vein thrombosis. Those who are at risk include
patients who:
○ Have recently had general or orthopedic
surgery.
○ Have cancer and receive medication
through a central venous access device.
○ Are over the age of 40 and obese.
○ Are taking oral contraceptives such as
estrogen.
○ Are pregnant, especially those who are
immobile or on bedrest (Medlineplus,
2017).

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Step 4 When is it appropriate to give heparin?

When? ● Post-operatively to patients who are at a high
risk for DVTs.
● To patients who are currently suffering from
DVTs (Medlineplus, 2017).

Step 5 Where is heparin stored?

Where? ● Heparin is stored in the pharmacy or on certain
medical floors. It is stored in a dark and cool
place (Medlineplus, 2017).
Where is heparin administered?
● Heparin is most commonly given intravenously
but can also be given subcutaneously and orally
(Heparin, n.d.) (Clinical Pharmacology, 2020).
● Heparin should not be injected intramuscularly,
this can cause large hematomas (Clinical
Pharmacology, 2020).

Step 6 How is heparin safely administered to patients?

How? ● Depending on providers orders heparin will be
set up to be administered continuously or
intermittently.
● Follow the pharmacy's instructions on
procedure per MAR (Heparin, n.d.).

Step 7 Registered nurses will be familiar with heparin use.

Monitoring and
Measuring

Procedure 2: Patient Assessment

Overview Details Quality

Records
Patient Steps to be taken before and after giving a patient
heparin.

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Assessment

Step 1 Assess for contraindications

Assessment before ● Corn hypersensitivity.

giving heparin ● Heparin hypersensitivity.
● Heparin-induced thrombocytopenia
(HIT).
● Porcine protein hypersensitivity
(Heparin, n.d.).

Assess patient for risk factors of DVT:

● Cancer
● Heart failure.
● Family history.
● Acute infection.
● Respiratory failure.
● Recent surgery (Joseph, et al., 2014).

Step 2 Assess the patient to determine that DVT or PE are

suspected using the following criteria:
Assessment if
DVT or PE are Assess for DVT:
suspected
● Refer to Wells Score to determine if there is a
high probability of DVT (Eckhardt & Jarvis,
2020). See “Appendix I” at the end of this
protocol.

Assess for PE and symptoms which include:

● Chest pain.
● Dyspnea
● Anxiety
● Restlessness
● O2 < 80%
● Cyanosis

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● Tachypnea (Eckhardt & Jarvis, 2020).

Step 3 Lab values to assess:

Assessment while ● Baseline CBC, aPTT, PT/INR.

on heparin therapy ● Daily aPTT.
● Daily CBC.
● Anti-Xa tests if indicated (Zehnder, 2019).

Step 4 Keep these precautions in mind to decrease risk of

major bleeding while on heparin therapy:
After Heparin
administration ● Know that the higher dose of anticoagulants, the
higher risk of bleeding.
● Know that bleeding is more common during the
first three months of anticoagulant therapy.
● Prior bleeding is a risk factor for future
bleeding.
● Older age is a risk factor for bleeding.
● Kidney disease, liver disease, diabetes, and
cancer can increase bleeding risk.
● Discontinue antiplatelet if not indicated.
● Use PPI with antiplatelet if antiplatelet is
indicated.
● Educate the patient not to take NSAIDs or
aspirin while on heparin.
● Educate the patient to use acetaminophen for
pain or fevers while on heparin.
● Oral heparin has lower risk of bleeding than
other types of heparin.
● Monitor patient blood pressure to prevent falls
caused by hypotension (Crowther & Garcia,
2020).

Assess for side effects (Procedure 3, Step 3).

Step 5 Nurses will assess the patient and report any significant
changes to the provider (Rules of the Idaho Board of

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Notify Provider if Nursing, 2019).

change in patient
status

Step 6 A Registered Nurse will assess patients before and

after Heparin administration for any adverse reactions.
Monitoring and
Measuring ● Assessments are routinely done per facility
policy.
● Assessment of lab results done daily (Warnock
& Huang, 2019).

Procedure 3: Patient Education

Overview Details Quality

Records
Patient Education Education to be given to patients upon receiving
Heparin therapy.

Step 1 D-Dimer
● A diagnostic test that looks at the cross-linked
Diagnostic Tests fibrin clot that is typically elevated in someone
that has a VTE.
Compression ultrasonography
● Preferred test to diagnose.
● Venous segments should easily compress, but
when there's a VTE it does not compress.
● This test compresses the veins to see if there is a
VTE.
● Utilizes a Doppler to identify which vessels to
compress (Wells, Anderson, 2013).
aPTT
● Used to monitor coagulation rates among

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patients.
anti-Xa test
● More sensitive and accurate in measuring
coagulation rates (Thom, Cameron, Robertson,
Watson, 2018).

Step 2 DVT:
● Unilateral calf/thigh pain.
Signs and ● Leg swelling.
symptoms ● Redness

PE:
● Dyspnea
● Chest pain.
● Both of those can happen (Wells, Anderson,
2013).
● Also see Procedure 6, Step 1 for more
information on signs and symptoms.

Step 3 Some common adverse reactions are:

● Hypotension
Adverse reactions ● Nausea
of heparin ● Shortness of breath.
● Hemorrhage
● HIT
● Local irritation.
● Alopecia at the affected site (Onishi, Ange,
Dordick, Linhardt, 2016).

Step 4 ● A state in which the body does not clot.

● An immune response is activated binding to the
Heparin Induced heparin molecules causing a thrombosis to
thrombocytopenia occur (Warkentin, 2018).
(HIT) ● (See procedure 3, step 3) for signs and
symptoms.
● Treatment will be to administer warfarin which
antagonizes vitamin K in the body (Warkentin,
2018).

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Step 5 ● Respiratory function can be altered.

● Increased risk for bleeding and bruising.
Safety ● Risk for Infection increased (Want, Blum et al.,
precautions 2015).
● See procedure 5, step 5 for bleeding
precautions.

Step 6 Registered Nurse will assess the patient's understanding

regarding Heparin therapy that was prescribed for them.
Monitoring and
Measuring

Procedure 4: Prevention of DVT & PE

Overview Details Quality

Prevention of Records
DVT & PE Steps in preventing patients from getting a DVT or PE.

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Step 1 Precautions to take:

● Administering heparin.
● Avoid tight clothing.
Prevention ● Physical activity.
Precautions ○ Frequent ambulation and range of
motion exercises will decrease the
chances of clot formation.
● Healthy diet.
○ Visit foodpyramid.com for ideas on how
to maintain a well-balanced diet.
● The use of compression stockings.
● Sequential compression devices (Joseph, et al.,
2014).

Step 2 Registered Nurse will teach preventative measures and

assess a patient's understanding through teach back.
Monitoring and
Measuring

Procedure 5: Administration
Overview Details Quality
Records
Administration Instructions for the administration of heparin.

Step 1 Assess patient (See procedure 2).

Assess the Patient

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Step 2
Obtain an order Obtain an order from the provider, written or verbal, for
heparin administration. Make sure that the order is in
the patient's chart (Idaho, 2013).

Step 3
Gather Supplies Gather all necessary supplies to administer heparin. See
and prepare Equipment and Suitable Environment on page 4.
medication Follow the 6 rights of medication administration
(Yoost & Crawford, 2020).

Step 4
Patient education Teach patients about the implications of heparin. For
more information on patient education, refer to
Procedure 3.

Step 5 Follow the pharmacy’s instructions on procedure per

Administer MAR.
Heparin

Step 6 Document that heparin was given per pharmacy’s

Documentation instructions. Also document patient response to
medication (Idaho, 2013).

Step 7 Clean the area and ensure that the patient is

Remove Supplies comfortable and safe.

Step 8 Promptly assess patient’s response after administration.

Evaluate See procedure 2, step 4.
effectiveness

Step 9
Monitoring and Nurse(s) will document each step of the protocol as
Measuring follows to ensure that this protocol was followed in
every case of VTE. Nurse Manager (or other directed
healthcare administrator) will review documentation to
ensure nurse compliance after each incidence of VTE.
Holding nurses accountable for following protocols
will increase compliance (Cline, 2016).

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Internal References:
● Proper documentation under each patient in the Cerner electronic health record.
● Provider orders.
● Location/type of heparin administered.
● Lab values.
● Pharmacy instructions about drug administration.

External References:
American Heart Association (2017). What is Venous Thromboembolism (VTE). American

Heart Association. https://www.heart.org/en/health-topics/venous-

thromboembolism/what-is-venous-thromboembolism-vte

Chapelle, C., Rosencher, N., Zufferey, P., Mismetti P., Cucherat, M., Laporte, S. & Meta-Embol

Group., (2014). Prevention of Venous Thromboembolic Events With Low-Molecular-

Weight Heparin in the Non-Major Orthopaedic Setting: Meta-Analysis of Randomized

Controlled Trials. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 30(8),

987-996. https://doi.org/10.1016/j.arthro.2014.03.009

Cline, Michelle A. “Increasing RN Accountability in Professional Practice.” JONA: The Journal

of Nursing Administration. vol. 46, no. 3, 2016, pp. 128–131.

https://doi.org/10.1097/nna.0000000000000311

Clinical Pharmacology [Internet]. Tampa (FL): Elsevier. C2020- [cited March 16].

http://www.clinicalpharmacology.com

Eckhardt, Ann & Jarvis, Carolyn (2020) Physical Examination and Health Assessment.

Elsevier.

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Elsevier (2020). Drawing blood and administering fluids: Checklist.

https://connect.elsevierperformancemanager.com/#/content/skills/13729/checklist

Garcia, David & Crowther, Mark. (2020). Risks and prevention of bleeding with oral

anticoagulants. UpToDate. https://www.uptodate.com/contents/risks-and-prevention-

of-bleeding-with-oral-anticoagulants

Gowthami A. & Ortel T., (2014). Heparin-Induced Thrombocytopenia. HHS Author

Manuscripts. 61: 77-90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153429/

Heparin. (n.d.) Clinical pharmacology. http://www.clinicalpharmacology-

ip.com/Forms/drugoptions.aspx?cpnum=289&n=Heparin&t=0

Idaho Department of Health and Welfare (2013). Rules and minimum standards for hospitals

in Idaho.16.03.14. https://adminrules.idaho.gov/rules/2013/16/0314.pdf

Idaho Office of the Administrative Rules Coordinator. (2016). Rules of the Idaho Board of

Nursing. 23.01.01. https://adminrules.idaho.gov/rules/current/23/230101.pdf

Joseph, L., Casanegra, A. I., Dhariwal, M., Smith, M. A., Raju, M. G., Militello, M. A., …

Bartholomew, J. R. (2014). Bivalirudin for the treatment of patients with confirmed or

suspected heparin-induced thrombocytopenia. Journal of Thrombosis and Haemostasis.

https://doi.org/10.1111/jth.12592

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., & Kwong, J., & Roberts, D.

(2017). Medical-surgical nursing: Assessment and management of clinical problems (10thed)

[eBook edition].

https://pageburstls.elsevier.com/#/books/9780323328524/cfi/6/130!/4/2/6/4@0:0.00

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Lilley, L. L., Collins, S. R., & Snyder, J. S. (2017). Pharmacology and the nursing process (8th

ed) [eBook edition].

https://pageburstls.elsevier.com/#/books/9780323358286/cfi/6/4!/4@0:0

Maynard G., Humber D., & Jenkins I., (2014). Multidisciplinary Initiative to Improve Inpatient

Anticoagulation and Management of Venous Thromboembolism. American

Journal of Health-System Pharmacy, 71(4), 305-310.

https://doi.org/10.2146/ajhp130108

Medline Plus. (2017). Heparin Injection-How Should This Medication Be Used? US National

Library of Medicine. https://medlineplus.gov/druginfo/meds/a682826.html

Newall, F. (2013). Anti-factor Xa (anti-Xa) assay. Haemostasis: Methods and Protocols, 992,

265-272. https://doi.org/10.1007/978-1-62703-339-8_19

Onishi, A., Ange, K.S., Dordick, J.S., & Linhardt, R.J. (2016). Heparin and anticoagulation.

Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute.

21, 1372-1392. http://www-

heparin.rpi.edu/main/files/papers/570d6646d2b110.85691577.pdf

Rules of the Idaho Board of Nursing, IDAPA 23.01.01 (2019). Idaho Administrative

Code. https://adminrules.idaho.gov/rules/current/23/230101.pdf

Thom, I., Cameron, G., Robertson, D., & Watson, H.G. (2018). Measurement of

rivaroxaban concentrations demonstrates lack of clinical utility of a PT, dPT and APTT

test in estimating levels. International Journal of Laboratory Haematology . 40:493–499.

https://doi.org/10.1111/ijlh.12846

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Thrombocytopenia. National Heart, Lung and Blood Institute.

http://www.nhlbi.nih.gov/book/export/html/4876

Warkentin, T.E. (2018). Heparin-induced thrombocytopenia-associate thrombosis: From arterial

to venous to venous limb gangrene. Journal of Thrombosis & Haemostasis, 16(11):

2128-2132. https://doi.org/10.1111/jth.14264

Warnock, L. B. & Huang, D. (2019). Heparin.

https://www.ncbi.nlm.nih.gov/books/NBK538247/

Wells, P. & Anderson, D. (2013). The diagnosis and treatment of venous thromboembolism.

American Society of Hematology, (1): 457–463. https://doi.org/10.1182/asheducation-

2013.1.457

Wang, M.L., Blum, K.A., Martin, P., God, A., Auer, R., Kahl, B.S., Jurczak, W., Advani,

R.H., Romaguera, J.E., Williams, M.E., Barrientos, J.C., Chmielowska, E., Radfod, J.,

Stilgenbauer, S., Dreyling, M., Jesrzejckak, W.W., Johnson, P., Spurgeon, S.E., Zhang,

L., Baher, L., Cheng, M., Lee, D., Beaupre, D.M., & Rule, S. (2015). Long-term follow-

up of MCL Patients treated with single-agent ibrutinib: updated safety and efficacy

results. American Society of Hematology, 126 (6): 739–745.

https://doi.org/10.1182/blood-2015-03-635326

Yoost, B. L. & Crawford, L. R. (2020). Fundamentals of nursing: Active learning for

collaborative practice (2nded) [eBook edition].

https://pageburstls.elsevier.com/#/books/9780323508643/cfi/6/4!/4/2/6/2/2@0:3.61

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Zhender, James. (2019). Clinical use of coagulation tests. UptoDate.

https://www.uptodate.com/contents/clinical-use-of-coagulation-tests?

search=providers%20order%20for

%20heparin&source=search_result&selectedTitle=7~150&usage_type=default&dis

play_rank=7#PATIENT_INFORMATION

Requirements:
Idaho State Board of Nursing (2016) has the requirement regarding patient education:

“The act of teaching patients and their families, for the purpose of improving or

maintaining an individual’s health status” (5-3-03)

The Idaho Department of Health and Welfare (2013) has the following requirements regarding

staff training and education:

“There shall be evidence of continuing education and training for the staff” (p.39)

Idaho Department of Health and Welfare (2013) has the following requirement regarding patient

documentation:

“The hospital shall maintain medical records that are documented accurately and timely,

and that are readily accessible and retrievable.” (12-31-91)

“12. Record Content. The medical records shall contain sufficient information to justify

the diagnosis, warrant the treatment and end results. The medical record shall also be

legible, shall be written with ink or typed, and shall contain the following information: iii.

Progress notes written by the nursing personnel.” (10-14-88)

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The Idaho State Board of Nursing (2016) requires the following regarding reporting patient

status changes:

“i. Observe and Report. The nurse shall observe the condition and signs and symptoms of

a patient, record the information, and report to appropriate persons any significant

changes.” (IDAPA, 04. i)

Idaho Department of Health and Welfare (2013) has set the following requirements for the

assessment and care plan of patients:

“Individual patient care plans shall be developed, implemented and kept current for each

inpatient. Each patient care plan shall include but is not limited to: (10-14-88)

a. Nursing care treatments required by the patient; and (10-14-88)

b. Medical treatment ordered for the patient; and (10-14-88)

c. A plan devised to include both short-term and long-term goals; and (10-14-88)

d. Patient and family teaching plan both for hospital stay and discharge; and (10-14-88)

e. A description of socio-psychological needs of the patient and a plan to meet those

needs.” (p.18)

Idaho Department of Health and Welfare (2013) has set the following requirements for

administration of medications:

“Drugs shall be dispensed and administered only upon written or verbal order of a

member of the medical staff authorized to prescribe. Verbal orders for drugs shall be

given only to those health care practitioners empowered to accept orders under Idaho law

and written hospital policies and procedures. Verbal or telephone orders shall be signed

or otherwise authenticated in a timely manner by the prescriber in accordance with the

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hospital's policy. The person accepting the verbal or telephone orders shall meet the

procedures set forth in Subsection 250.09” (p. 22)

Quality Assurance and Sustainability:

Quality assurance will be determined after the patient’s stay at the hospital. This

experience will give insights into each patient’s individualized experience, and how if they

thought heparin prevented VTEs during their stay. Asking each patient about their opinion on

heparin will allow the hospital to see what worked for the patient or what could be changed to

improve their stay. After the patient’s stay, they will be asked to rate how they felt heparin

therapy helped them.

Another way in which quality will be maintained is that all staff involved in the

administration of heparin, will be mandated to take training on heparin therapy. This will ensure

that each staff member is staying up to date on the most current evidence-based practice to

administer and understand the effects of heparin therapy to prevent VTEs.

Sustainability will be monitored through the patient’s understanding of education that is

going on. Not only does the medication need to be given, but the patient should have an

understanding of heparins side effects, what it does, and why the provider prescribed it. This will

demonstrate that the patient not only understands their treatment plan, but that it also shows the

nurse understand heparin therapy. The charge nurse will routinely ask each patient on heparin if

they know what it’s for, what it does, and why they are getting it and will document patient

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education accordingly in the patient's electronic health record. By doing this it will ensure that

patient’s not only understand their care plan, but also that the nurse taking care of them does too.

Disclaimer:

This resource is meant to assist staff and will not apply to all possible circumstances. Although

safety is the main goal, it cannot always be guaranteed. Unique circumstances may require

adaptation from this protocol.

Appendix I

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