Increasing the Rate of Venous Thromboembolism Chemoprophylaxis Administration Using the Electronic Medical Record

J Pharm Pract. 2024 Oct;37(5):1157-1163. doi: 10.1177/08971900241232565. Epub 2024 Feb 14.

Abstract

Introduction: Venous thromboembolism (VTE) remains a leading cause of preventable harm among hospitalized patients. Pharmacologic VTE prophylaxis reduces the rate of in-hospital VTE by 60%, but medication administration is often missed for various reasons. Electronic medical record (EMR) prompts may be a useful tool to decrease withholding of critical VTE chemoprophylaxis medications. Methods: In August 2021, an EMR prompt was implemented at a tertiary referral academic medical center mandating nursing staff to contact a provider for approval before withholding VTE chemoprophylaxis. A pre-intervention group from August 2020 to August 2021 was compared to a post-intervention group from August 2021 to August 2022. Rates of VTE chemoprophylaxis withholding were compared between the groups with a P < .01 considered significant. Results: A total of 16,395 patients prescribed VTE chemoprophylaxis were reviewed, with 13,395 (81.7%) receiving low molecular weight heparin. Of the 16,395 patients included, 10,701 (65.3%) were medical and 5694 (34.7%) were surgical. Patients in the pre-intervention cohort (n = 8803) and post-intervention cohort (n = 7592) were similar in hospital length of stay and duration of DVT prophylaxis. In the post-intervention group, the frequency of surgical patients with at least one missed dose had increased by 4.2% (P = .002), with the trauma and acute care surgery (TACS) show an increase of 6.6% (P < .001). However, the frequency of medical patients and non-TACS patients with missed doses decreased by 3.1% (P = .002) and 1.0% (<.001), respectively. Conclusions: EMR prompts appear to be a low-cost intervention that increases the rate of VTE prophylaxis administration among medical and elective surgery patients.

Keywords: anticoagulation; internal medicine; medication safety; pharmacy administration; pharmacy education.

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Chemoprevention / methods
  • Cohort Studies
  • Electronic Health Records*
  • Female
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Venous Thromboembolism* / prevention & control

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight