The introduction of combined gynecological operation pathway with optional pathway for preoperative heparin bridging

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  • Ogata Masatomo
    Department of General Internal Medecine, Japanese Red Cross Kumamoto Hospital
  • Arakane Futoshi
    Department of Obstetrics and Gynecology, Japanese Red Cross Kumamoto Hospital
  • Koyama Miharu
    Department of Pharmacy, Japanese Red Cross Kumamoto Hospital
  • Terasaki Tadashi
    Department of Neurology, Japanese Red Cross Kumamoto Hospital

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Other Title
  • 婦人科疾患における術前ヘパリンブリッジングのためのオプショナルパスの導入
  • フジンカ シッカン ニ オケル ジュツゼン ヘパリンブリッジング ノ タメ ノ オプショナルパス ノ ドウニュウ

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<p>We use surgical-based critical pathways for many patients with gynecological disease. Occasionally, however, adjustments in treatment are required for patients with complications or underlying diseases. We developed an optional pathway, which is implemented by our electronic record system and adds extra functions to the conventional critical pathways. In this paper, we describe the development of an optional pathway for standardizing heparin bridging in patients prescribed with anticoagulants. Multiple inter-departmental discussions were held in the creation of this optional pathway.</p><p>We have used this optional pathway in 9 cases so far. Using this pathway has standardized the way heparin is injected and the nursing instructions for heparin use in our ward. We have also written an information sheet for patients on heparin injections during hospitalization. The optional pathway has standardized and improved the medical care provided to these patients. On the other hand, we have experienced some problems, such as with the regulation of the activated partial thromboplastin time and outcome evaluations. After addressing these problems and altering the plan-do-check-act cycle, we consider that the optional pathway will be more useful than the conventional pathway.</p><p>This is the first optional pathway employed at our hospital. We could develop other optional pathways for patients with different complications or underlying diseases, and they might result in the provision of better standardized care.</p>

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