Deep vein thrombosis (DVT)–related pulmonary embolism (PE) is the most common cause of preventable death in hospitalized patients. A large tertiary‐care academic medical center focused on increasing venous thromboembolism (VTE) prophylaxis for all medicine inpatients to reduce the risk of developing a DVT or PE. Admission order sets that prompt physicians to start VTE prophylaxis or to document a contraindication are effective but do not address situations when a contraindication on admission may no longer be valid later in the hospital stay. In addition, once prophylaxis is discontinued for procedures or subsequent bleeding risks, it is often not restarted once the contraindication is no longer present. To address this, a process was developed that reminded physicians 6 hours after admission and every subsequent 24 hours to start or resume VTE prophylaxis. This allowed contraindications to prophylaxis to be reevaluated throughout the entire inpatient stay.
The hospital developed a VTE prophylaxis reminder in the electronic medical record. If there was no pharmacoprophylaxis ordered on admission, an alert triggered within 6 hours of admission and then every subsequent 24 hours, notifying the physician that the patient was at risk for VTE and pharmacoprophylaxis should be considered. The alert provided 3 ordering options: an order for prophylactic low‐molecular‐weight heparin, prophylactic unfractionated heparin, and an order that documented that pharmacoprophylaxis is contraindicated. Also, if the order for pharmacoprophylaxis is contraindicated was selected, then an additional alert would appear recommending that pneumatic compression devices be ordered. In addition, the pharmacoprophylaxis is contraindicated order automatically expired after 24 hours. Once this order expired, the same alert would trigger every 24 hours prompting the physician to reevaluate the prophylaxis decision.
The alerts were implemented at the end of April 2010. The starting of prophylaxis within 24 hours of admission was used as a proxy for appropriate prophylaxis throughout the inpatient stay since these alerts triggered within 6 hours of admission and then daily. Before the alerts, 90% of medicine patients received VTE prophylaxis within 24 hours of admission or had a documented contraindication. After the alerts, this rate increased to 97% for all medical patients (Fig. 1).
System alerts are an effective tool to remind physicians to start VTE prophylaxis and reevaluate contraindications to pharmacoprophylaxis throughout the patient's stay. Because many contraindications are temporary, these reminders can ensure that VTE prophylaxis is maintained daily.
H. Shah ‐ none; J. Van Dyke ‐ none; D. Liebovitz ‐ none; A. Bobb ‐ none; E. Standardi ‐ none; C. Watts ‐ none; S. Greene ‐ none
To cite this abstract:Shah H, Dyke J, Liebovitz D, Bobb A, Standardi E, Watts C, Greene S. Use of 24‐Hour Electronic Alerts to Increase Venous Thromboembolism (Vte) Prophylaxis Usage in Medicine Patients. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 109. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/use-of-24hour-electronic-alerts-to-increase-venous-thromboembolism-vte-prophylaxis-usage-in-medicine-patients/. Accessed April 1, 2020.