To increase the use of venous thromboembolism (VTE) prophylaxis, a multidisciplinary team at an academic medical center developed a VTE prophylaxis protocol that was added into medicine admission and surgical postoperative order sets. In this protocol, the physician was given several options for VTE prophylaxis. The options included low‐molecular‐weight heparin (LMWH), unfractionated heparin (UFH), mechanical compression, and an option for “chemoprophylaxis is contra indicated.. At least 1 option had to be checked in the protocol by the physician. Prophylaxis usage within the first 24 hours of admission was then monitored to understand the protocol's impact on ordering practices.
VTE prophylaxis usage was monitored in surgical and medicine inpatients (obstetric, pediatric, and psychiatric cases were excluded). Prophylaxis usage was monitored by querying all orders comprising 22,568 encounters placed within 24 hours of admission in the hospital's electronic data warehouse. If an order had been placed for LMWH, UFH or warfarin, then the patient was considered as having received pharmacologic prophylaxis. If an order had been placed for mechanical compression and there was not an order for pharmacologic prophylaxis, then the patient was considered as having received mechanical prophylaxis. If an order had not been placed for either phamnacologic or mechanical prophylaxis within the first 24 hours of admission, then that patient was considered “missed.”
In December 2008, the average prophylaxis rates within 24 hours of admission were: 58.9% pharmacologic prophylaxis, 25.9% mechanical prophylaxis, 15.2% did not receive any prophylaxis. For January 2009, after the protocol was implemented, the average prophylaxis rates within 24 hours of admission were: 58.7% pharmacologic prophylaxis, 30.4% mechanical prophylaxis, and 10.9% did not receive any prophylaxis.
Adding the VTE prophylaxis protocol into admission and surgical postoperative order sets decreased the number of patients not receiving VTE prophylaxis (i.e., missed patients). However, results show that mechanical prophylaxis usage increased instead of pharmacologic prophylaxis, This suggests that some patients may be underprophylaxed and could have been candidates for pharmacologic prophylaxis. Thus, although strategies to increase VTE prophylaxis compliance with the use of order sets may show an improvement in overall prophylaxis rates, a proportion of patients may be underpropfiylaxed. Strategies should be developed to evaluate this underprophylaxis group and increase their pharmacologic prophylaxis rates.
H. Shah, none; J. Van Dyke, none; S. Greene, none, C. Watts, none.
To cite this abstract:Shah H, Dyke J, Greene S, Watts C. Man datory VTE Prophylaxis Protocol Shows Increase in Overall Compliance But May Result in Underprophylaxis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 131. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/man-datory-vte-prophylaxis-protocol-shows-increase-in-overall-compliance-but-may-result-in-underprophylaxis/. Accessed April 4, 2020.