PURPOSE: Deep venous thrombosis(DVT) is common/preventable medical condition contributing to increased morbidity/mortality/length of stay(LOS)/cost/pulmonary embolus(PE). The purpose of our study was to evaluate adequate prophylaxis [our definition of adequate DVT prophylaxis was based on the Seventh ACCP Conference(SACCPC) Guidelines on Antithrombotic and Thrombolytic Therapy] and activity order in hospitalized patients with hospital acquired DVT in a community teaching hospital.
METHODS: Retrospective chart review of hospitalized patients from January 2004 to September 2005 who developed DVT while in the hospital. Analysis included demographics, admitting service/unit, activity order, type of DVT prophylaxis used, hospital day when the diagnosis of DVT was made, location of DVT, LOS, development of PE and clinical outcomes.
RESULTS: 72 patients were identified including 46(64%) females and 26(36%) males. 37(51%) of patients were medical, 20(28%) surgical and 15(21%) orthopedic. 52(72%) patients were on medical/ surgical units and 20(28%) were in ICU/CCU. 14/72(19%) patients had no activity order, 25(35%) had bed rest order, 14(19%) as tolerated order and 19(27%) out of bed order(OOB).There was no DVT prophylaxis in 19/37(51%) medical, 6/20(30%) surgical and 3/15(20%) orthopedic patients. There was inadequate prophylaxis in 6/37(16%)medical, 7/20(35%) surgical and 5/15(33%) orthopedic patients. 59/72(82%) patients developed lower extremity DVT and 13/72(18%) upper extremity DVT. The DVTs occured on average on hospital day 15. 9(13%) patients were diagnosed with PE (2 medical, 5 surgical and 2 orthopedic). 6(8%) patients expired and none from PE.
CONCLUSION: 53(73%) of all the patients had no activity order, bed rest order, or as tolerated order(this is vague order). 46(64%)had either no or inadequate DVT prophylaxis. These DVTs most likely contributed to increased LOS and definitely contributed to an increase in morbidity in hospitalized patients.
CLINICAL IMPLICATIONS: All patients should be screened for DVT prophylaxis on admission and regularly during hospitalization. All patients should have OOB orders whenever possible. Mandatory admission forms that include patient activity orders and screening for DVT prophylaxis should implemented in all hospitals. DVT prophylaxis should be consistent with SACCPC guidelines.
DISCLOSURE: Edgardo Soto, None.