Venous thromboembolism (VTE) represents significant morbidity and mortality challenges for hospitals. Despite the implementation of risk stratification methodologies and admission order sets to ensure VTE prophylaxis at most hospitals, studies indicate that a significant proportion of medicine inpatients are not receiving VTE pharmacoprophylaxis. Most current strategies for improving prophylaxis have focused on education and process improvement changes aimed at house staff and admitting physicians. Our academic medical center leveraged the involvement of our clinical pharmacists on inpatient floors in improving prophylaxis for VTE through chart review, documentation in a pharmacy database, and physician notification.
Inpatient clinical pharmacists evaluated all medicine charts daily for the presence of a VTE pharmacoprophylaxis order or a documented contraindication to prophylaxis. If either was lacking, house staff and/or attending hospitalists were contacted to start prophylaxis or document a contraindication. Appropriate contraindications to pharmacologic prophylaxis were standardized across disciplines by the VTE leadership team. Once prophylaxis information was obtained, it was entered daily into a pharmacy‐based clinical decision support system. Based on chart review and discussion with physicians, 1 of the following was entered into the pharmacy database: on prophylaxis, prophylaxis contraindicated long term, prophylaxis temporarily contraindicated with follow‐up needed, or prophylaxis refused by physician. If pharmacologic prophylaxis was temporarily contraindicated, this was noted, and physicians were contacted again the next day, if needed. If pharmacologic prophylaxis was refused by the physician without a valid contraindication, an escalation procedure was developed that included notifying VTE project team leadership, who then contacted individual physicians to ensure compliance with prophylaxis.
Pharmacists reviewed all charts daily, which totaled more than 12,000 patients in an 8‐month period. Pharmacist notifications to physicians resulted in the initiation of pharmacologic prophylaxis on an average of 113 patients per month over an 8‐month period and ranged from 93 to 152 patients starting prophylaxis monthly due to this new process (Fig. 1).
Pharmacist interventions including chart review, evaluation of appropriate contraindications, and subsequent discussion with ordering physicians led to initiation of pharmacologic prophylaxis on 905 patients at our academic medical center over 8 months. Leveraging the use of clinical pharmacists of inpatient units represents an added opportunity to improving pharmacologic prophylaxis compliance.
H. Shah ‐ none; J. Van Dyke ‐ none; D. Kotis ‐ none; J. Patel ‐ none; A. Bobb ‐none; N. Chapman ‐ none; S. Greene ‐ none
To cite this abstract:Shah H, Dyke J, Kotis D, Patel J, Bobb A, Chapman N, Greene S. The Use of Pharmacists As an Effective Strategy to Improve Venous Thromboembolism Prophylaxis. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 110. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/the-use-of-pharmacists-as-an-effective-strategy-to-improve-venous-thromboembolism-prophylaxis/. Accessed March 28, 2020.