American college of physicians’ clinical practice guidelines raises the question of mortality benefit from venous thromboembolism (VTE) prophylaxis and excessive bleeding risk based on newer research outcomes. In this context, a study was designed to measure the impact of electronic order entry based on standardized risk assessment, specialty specific, VTE prophylaxis, and the number of symptomatic VTE and pulmonary embolism in acute rehabilitation inpatient unit.
Electronic patient order entry and electronic records of all patients admitted on the rehabilitation unit in the Academic Institution for one year were reviewed for assessment of VTE risk factors, and implementation of a specialty specific VTE prophylaxis order sets. International Classification of Diseases9 discharge diagnostic codes for VTE and pulmonary embolism were tracked by administrative staff. Incidence of VTE and pulmonary embolism were compared before and after the implementation of electronic order entry system.
The study population mean age was 56 [pm] 15 years. Men to women ratio were 2:1. Total of 31 patients had discharge diagnostic codes for VTE and pulmonary embolism in 12month period. Two thirds of them were diagnosed with deep vein thrombosis and pulmonary embolism in the immediate post operative period prior to transfer to rehabilitation unit (majority of the patients had complicated surgeries like renal and lung transplant, radical cancer dissection, spinal and neuro surgery). Next common comorbid condition was end stage renal disease on dialysis. With the paper order entry of VTE prophylaxis order sets the compliance rate at inpatient rehabilitation unit was 98%. After the implementation of electronic order entry the compliance rate achieved the target of 100%. The number of VTE and pulmonary embolism during paper order entry was 8 per 1000. The number of VTE and pulmonary embolism steadily decreased to 4 per 1,000 after the implementation of electronic order entry (P < 0.05). The incidence of VTE and pulmonary embolism in our rehabilitation unit was significantly lower than national average and was only 0.4%. One patient (status post neuro surgery for Glioblastoma Multiforme) had hemorrhagic stroke from therapeutic anticoagulation.
Implementation of electronic patient order entry system based on standardized VTE risk assessment and specialty specific order set resulted in a significant improvement in compliance with VTE prophylaxis and reduction in the number of symptomatic VTE and pulmonary embolism in an academic hospital inpatient rehabilitation unit.
To cite this abstract:Prakasa K, Streiff M, Mayer S. Electronic Patient Order Entry for Venous Thromboembolism Prophylaxis Has Significantly Reduced the Occurrence of Venous Thromboembolism in Rehabilitation Inpatients. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97587. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/electronic-patient-order-entry-for-venous-thromboembolism-prophylaxis-has-significantly-reduced-the-occurrence-of-venous-thromboembolism-in-rehabilitation-inpatients/. Accessed March 28, 2020.