PURPOSE: Research has demonstrated that utilization of electronic reminders within an inpatient note improves venous thromboembolism (VTE) prophylaxis rates. We sought to determine whether implementing a specifically designed and easily reproducible electronic reminder would improve patient-specific prophylaxis in accordance with 8th edition ACCP guidelines.
METHODS: We collaborated with the informatics and pharmacy departments to develop an electronic reminder within the inpatient electronic medical record (EMR). This reminder provided a consolidated version of 8th edition ACCP guidelines to assist in determining appropriate, patient specific VTE prophylaxis. We collected data on prophylaxis rates following implementation, including information on relevant risk factors for VTE, and overall and group specific prophylaxis rates (pre and post intervention). We analyzed VTE diagnoses during and after patient hospitalizations, pre and post intervention, to determine outcome effects. Data were analyzed using SAS version 9.1.
RESULTS: We collected data on 1498 patients (54.8±20.7 years old, 60.8% male) before and 1218 (56.7±21.7 years old, 59.9% male) patients after incorporation of the electronic reminder. Excluding patients who required treatment dose anti-coagulation, 46.6% of patients before and 65.4% after the reminder were on appropriate prophylaxis per ACCP guidelines (p <0.001). Among patients with heart failure and renal insufficiency, prophylaxis rates before and after were 58.2% versus 79.6% (p=0.022) and 58.5% versus 71.0% (p=0.066), respectively. There were fewer patients diagnosed with a VTE after our reminder was added (0.2% v 4.4%; p<0.001). Of those patients who did not have prophylaxis addressed, most had chemical measures omitted entirely, rather than inappropriate medication or dosing.
CONCLUSION: At our hospital, an electronic reminder with specific recommendations improved patient appropriate prophylaxis rates. VTE events were decreased, during and after hospitalization. The system is easily reproducible and applicable to other facilities. Completion of documentation was mandatory within the EMR, ensuring provider attention.
CLINICAL IMPLICATIONS: Incorporation of a patient-specific EMR electronic reminder improved prophylaxis and event rates for VTE.
DISCLOSURE: Sarah Petteys, No Financial Disclosure Information; No Product/Research Disclosure Information