Background: Bivalirudin, a potent anticoagulant used in critical care settings, demands precision in administration to mitigate risks. Current literature lacks substantial evidence on the safety and efficacy of nurse-driven protocols for low-volume, elevated risk administration of intravenous bivalirudin. This poster outlines a quality initiative aimed at assessing and enhancing the safety of bivalirudin administration through the implementation of nurse-driven protocols.

Objective: The primary objective of this quality initiative is to evaluate the impact of nurse-driven protocols on the safety and efficacy of bivalirudin administration specifically for the HITT and ECMO patient population in a critical care setting. By empowering nurses with a structured protocol and workflow, we aim to enhance patient safety, reduce errors, and optimize the utilization of this high-risk medication.

Methods: The initiative will adopt a pre- and post-implementation study (mixed method). Critical care nurses will undergo comprehensive education and training on bivalirudin pharmacology, dosage calculations, and safety protocols to include documented independent double checks at pump titration. Nurse-driven protocols will be evaluated in critical care units. Data will be collected on adverse events, dosage accuracy, and patient outcomes, utilizing electronic health records and incident reporting systems. Statistical methods will be employed for quantitative analysis, while qualitative analysis will identify factors influencing feasibility and practicality.

Results anticipated: 1) Time to bivalirudin steady state defined by two consecutive aPTTs with the target range and the percentage of aPTT values. 2) Evaluation of the incidence of adverse events related to bivalirudin under nurse-driven protocols. 3) Assessment of the effectiveness of nurse-driven protocols in achieving therapeutic goals.

Conclusion: This quality initiative is to contribute essential evidence to the literature, addressing the current gap in knowledge surrounding bivalirudin administration by nurses. The initiative aims to enhance patient safety and promote the responsible utilization of bivalirudin through nurse-driven protocols.

Phalan Bolden MSN, MBA, FNP-C

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