Development and implementation of a program to assess medical patients’ need for venous thromboembolism prophylaxis

Abstract

The development and implementation of a program to assess medical patients' need for venous thromboembolism (VTE) prophylaxis are described. The pharmacy services, medicine, and information services departments at Hartford Hospital collaborated to institute a program to improve VTE prophylaxis in medical patients. After baseline VTE prophylaxis compliance was assessed, the departments developed an intervention consisting of a message to be displayed to providers using the institution's computerized prescriber-order-entry (CPOE) system as a reminder to assess the current patient for VTE risk factors and the need for VTE prophylaxis. The message was displayed when a patient met predefined criteria for VTE risk factors. The message would not continue to be displayed once either mechanical or pharmacologic VTE prophylaxis was an active order on the patient's medication profile. Extensive education about the program was provided to hospital staff, pharmacists, physicians, nurse practitioners, physician assistants, and nurses. The program was implemented in March 2007 on a pilot medical floor. To measure the impact of the program, a retrospective chart review was conducted using the risk-assessment tool developed. The VTE prophylaxis compliance rate post-implementation was 93%, compared with 49% preimplementation of the program ( p < 0.001). Before the program, only 25% of patients with a contraindication to pharmacologic therapy received mechanical prophylaxis, compared with 100% after program implementation. Use of message alerts through a CPOE system and an interdisciplinary team approach to assess patients' risk for VTE appeared to improve the use of VTE prophylaxis in medical patients.