Improving the adoption of an electronic clinical decision support tool and evaluating its effect on venous thromboembolism prophylaxis prescribing at a Sydney tertiary teaching hospital

Abstract

AbstractBackgroundAn electronic venous thromboembolism (VTE) prophylaxis clinical decision support (CDS) tool was implemented in an electronic medication management system at an Australian tertiary teaching hospital. The VTE CDS had not been clinically validated nor widely adopted.AimThis study evaluated the effectiveness of the VTE CDS for improving risk‐appropriate prescribing of VTE prophylaxis, a peer‐to‐peer strategy for improving adoption of the VTE CDS and the effects of the strategy on VTE risk assessment documentation, risk‐appropriate prophylaxis prescribing rate and user acceptability of the VTE CDS.MethodsNominated junior medical officers were trained to educate and promote the use of the VTE CDS to target colleagues over 6 weeks. Pre‐ and postintervention audits of VTE risk assessment and prophylaxis prescribing were conducted. A user acceptance survey was distributed.ResultsAnalysis of pre‐ and postintervention audit data (n = 198 for each) revealed no significant differences in rates of VTE CDS adoption or risk‐appropriate VTE prophylaxis prescribed. More patients had risk‐appropriate prophylaxis prescribed when the VTE CDS was used (90%; 63/70) than when it was not used (71.5% (233/326); p = 0.001). Documented evidence of VTE risk assessment increased significantly from 51.5% (102/198) to 68.2% (135/198) following the intervention (p < 0.001). Most survey responses were favourable towards VTE CDS usability despite limitations.ConclusionPeer‐to‐peer promotion was unsuccessful in improving VTE CDS adoption in this study. Findings suggest VTE CDS use is associated with more appropriate VTE prophylaxis prescribing decisions and may improve risk assessment documentation. Future studies should examine strategies to sustainably improve adoption of VTE CDS and patient outcomes.