Blank spaces in the management of venous thromboembolism prophylaxis at surgical departments and the impact of a clinical pharmacist

Abstract

A venous thromboembolism (VTE) prophylaxis policy should be in place at all hospitals. While professional societies provide general guidance, they do not take into account the full range of procedures in this area. The aim of this study was to fill these “blank spaces” and design a VTE prophylaxis system which would reflect the wide range of surgical procedures. We conducted an extensive literature review. Surgeons were subsequently asked to help score procedures according to VTE and bleeding risk while taking into consideration procedure type and duration, surgical techniques, etc. Results: Clinical pharmacists proposed a standardized VTE prophylaxis protocol. For some surgical fields the Caprini risk assessment model (RAM) was adapted. A unique VTE prophylaxis system was created for surgical fields where Caprini RAM has not been validated. We proposed dosage adjustments for obese patients and for patients with renal impairment. A dedicated software application was developed. The implementation of the VTE prophylaxis system resulted in a uniform and more rational prescription of pharmacological and mechanical prophylaxis as well as in financial savings. The development of the app increased compliance with the system and, in combination with real-time auditing, significantly improved safe drug administration practices at Military University Hospital Prague. The system is unique in continental Europe and contains wide range of surgical procedures and matching VTE prophylaxis, which has never before been published in this scope. It demonstrates the contribution of clinical pharmacists to the improvement of hospital care quality.