{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:10:46Z","timestamp":1787019046351,"version":"build-2736575974"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Therapeutic intensity unfractionated heparin (UFH) infusions require titration to target a therapeutic activated partial thromboplastin time (aPTT) or UFH anti-Xa. At The Johns Hopkins Hospital (JHH) and Johns Hopkins Bayview Medical Center (JHBMC), a computerized nurse-managed UFH calculator was built into the electronic health record (EHR) to improve adherence to institutional nomograms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study evaluated the impact of implementation of an EHR-embedded UFH calculator on nurse-managed UFH nomogram adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective, observational cohort study was conducted at 2 institutions within one health system. Patients admitted to adult services who received nurse-managed UFH for at least 4 consecutive hours were included. Patients admitted between March 2019 and March 2021 constituted the pre-implementation cohort and patients admitted August 2021 through August 2023 were included in the post-implementation cohort. The primary outcomes were nurse-managed UFH nomogram adherence, management of critical aPTT results, and therapeutic aPTT achievement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 2128 patients were included in the pre-implementation cohort and 2517 in the post-implementation cohort. The mean age was 61 for both the pre- and post-implementation cohorts. The post-implementation cohort experienced an increase in adherence to initial bolus dose recommendations when compared with the pre-implementation cohort (85.9% vs 92%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) as well as increased adherence to correct initial infusion doses (80.8% vs 95.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Infusion dose adjustment error rates were reduced in the post-implementation cohort (4.9% vs 1.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Fewer patients experienced nomogram nonadherence errors in the post-implementation cohort (20.2% vs 5.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Critical aPTT nomogram adherence improved after calculator implementation for resumption at the recommended dose (72.4% vs 94.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). However, the time to therapeutic aPTT achievement was similar between pre-implementation and post-implementation cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance:<\/jats:title>\n                    <jats:p>A stewardship initiative to implement an EHR-embedded nurse-managed UFH calculator significantly increased adherence to nomogram-recommended initial doses and dose adjustments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10600280251395053","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T10:37:21Z","timestamp":1764585441000},"page":"574-582","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of Nurse-Managed Heparin Nomogram Adherence After Implementation of an Electronic Health Record\u2013Embedded Heparin Calculator: An Antithrombotic Stewardship Initiative"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4006-9260","authenticated-orcid":false,"given":"Taylor P.","family":"Robichaux","sequence":"first","affiliation":[{"name":"Ochsner LSU Health Shreveport Academic Medical Center, Shreveport, LA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vi","family":"Gilmore","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Willits","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Miranda","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Lindsley","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary Joy","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Watt","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Kiruthi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhi","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Streiff","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Yui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-4702","authenticated-orcid":false,"given":"Kathryn","family":"Dane","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16201"},{"key":"e_1_3_2_3_2","unstructured":"Authority PPS. Oral anticoagulants: a review of common errors and risk reduction strategies advisory. Pennsylvania Patient Safety Authority. Accessed June 7 2024. http:\/\/patientsafety.pa.gov:80\/ADVISORIES\/Pages\/201506_54.aspx"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2017.03.007"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2019.12.004"},{"key":"e_1_3_2_6_2","unstructured":"The Joint Commission. National patient safety goals NPSG 03.01.05. Accessed Jun 7 2024. www.jointcommission.org\/assets\/1\/18\/NPSG_Chapter_Jan2013_AHC.pdf"},{"key":"e_1_3_2_7_2","unstructured":"Institute for Safe Medication Practices. Improving medication safety with anticoagulant therapy. 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