PURPOSE: Although few question the value of venous thromboembolism prophylaxis (VTE-P) clinician compliance rates historically are low. We explored the impact of embedding ACCP guidelines into our CPOE system.
METHODS: CPOE pathways based on ACCP VTE-P guidelines were developed for a broad spectrum of adult med-surg patients and ordering clinicians were mandated to view the pathway. Electronic notification and discussion forum approaches were utilized to introduce the upcoming mandated screens. As the majority of patients at the time of implementation would already be in house we temporarily modified the initial screen to permit direct exit from the pathway if the clinician selected “patient already on prophylaxis”. The clinician could also choose to opt out by stating the patient was pediatric. VTE-P options primarily included pharmacological (heparin, enoxaparin), sequential compression devices or full ambulation. Dosing was pre-determined and part of the CPOE pathway. Clinicians were not required to order prohylaxis, only view the pathway. We evaluated VTE-P ordering pre and post viewing mandated pathway implementation (April 20th at 02:00). Patients in whom the intent was full anticoagulation (IV heparin, warfarin, agents for HIT) were excluded from analysis.
RESULTS: VTE-P compliance pre-intervention was 73.25% and post 79.20% (p < 0.05). An increase in activity orders for full ambulation was noted 5.96% to 9.93% (p < 0.05). No differences were seen with regard to proportions of pharmacologic or mechanical prophylaxis ordered.
CONCLUSION: CPOE viewing mandated screens do increase physician compliance in ordering VTE-P. The impact might be more substantial if beyond viewing, ordering of prophylaxis was mandated. Presently, the clinician may exit pathway without order entry or by choosing the temporary option of “patient already on prophylaxis”. This study did not evaluate appropriateness of dosing pharmacologic agents. The CPOE pathway provided dosages and frequencies consistent with ACCP guidelines, whereas prior to the mandated screens dosing was chosen by the clinician without guideline recommendations or choices.
CLINICAL IMPLICATIONS: CPOE mandated screens improve clinician VTE-P compliance, and may reduce incidence of VTE.
DISCLOSURE: Yelena Kogan, None.