Overprescribing heparin

[NewGradNurse3, BSN, RN]

Does anyone else feel like doctors overprescribe heparin? I understand for pts who are bedbound or post surgical, but for ambulatory patients who get up and go to the bathroom, who are there for medical issues that don't seem related to clotting, I don't understand why we are giving them subq heparin 3 times a day - it just seems like literally almost every patient gets heparin. It seems excessive and doesn't it just add whatever risks of bleeding and other side effects unnecessarily?

[chare]

If you think that heparin is not appropriate, for whatever reason, have you discussed your concerns with the ordering provider?

[NewGradNurse3, BSN, RN]

I have, but it's done so often that I don't address it with every single patient/provider. At times when I have brought it up (or told providers that a pt refused heparin but that they're ambulatory, etc), the provider is just like, "OK, sure you can d/c the order". It just seems like they're ordering it automatically rather than actually thinking about whether it's appropriate for that pt. I'm curious if other nurses see this happening and how you deal with it.

 

[chare]

12 minutes ago, NewGradNurse3 said:

... It just seems like they're ordering it automatically rather than actually thinking about whether it's appropriate for that pt.  I'm curious if other nurses see this happening and how you deal with it.

It is entirely possible that that heparin is preselected on the order set.  As far as how I address this, if I have questions about why a medication (or other intervention) was ordered, or don't believe it appropriate, I always discuss this with the ordering provider.