Clinical research studyAdherence to Pharmacological Thromboprophylaxis Orders in Hospitalized Patients
Section snippets
Methods
Brigham and Women's Hospital has a computer system that integrates medical, laboratory, nursing, and pharmacy information. Physicians enter all medication orders into the computer order entry system. A pharmacist reviews the medications, and, once approved, the medications become part of the electronic medication administration record. Nurses are prompted to administer medications as part of a work shift to-do list (Figure 1). The nurse scans the medication's bar code, the patient
Results
Of the 125 patients receiving LMWH prophylaxis, 103 (82.4%) were admitted to the Medical Service. Patients were most often admitted to the Oncology, General Medicine, and Neurology Services (Table 1). Of the 125 patients receiving UFH prophylaxis, UFH was prescribed 3 times daily for 97 (77.6%) and twice daily for 28 (22.4%) patients. UFH 3 times daily was most commonly prescribed in Thoracic Surgery, Gastroenterology, General Medicine, and Surgical Oncology patients. UFH twice daily was most
Discussion
Our drug utilization review of 250 consecutive patients demonstrates that twice daily or 3 times daily regimens of UFH have adherence rates of 87%. Adherence improves to 95% with once daily LMWH. Only 47% of patients ordered for UFH regimens received every scheduled dose, whereas adherence to every scheduled dose of LMWH was 78%.
Patient refusal was the most frequent reason for omitted doses, regardless of whether UFH or LMWH was ordered. Patients might refuse injection-based prophylaxis because
References (17)
- et al.
Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest
(2008) - et al.
Thromboprophylaxis rates in US medical centers: success or failure?
J Thromb Haemost
(2007) - et al.
; ENDORSE InvestigatorsVenous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study
Lancet
(2008) - et al.
Knowledge of venous thromboembolism (VTE) prevention among hospitalized patients
J Vasc Nurs
(2008) The Surgeon General's call to action to prevent deep vein thrombosis and pulmonary embolism
Medicare and Medicaid move aggressively to encourage greater patient safety in hospitals and reduce never events
National consensus standards for prevention and care of venous thromboembolism (VTE)
- et al.
Hospitals' compliance with prophylaxis guidelines for venous thromboembolism
Am J Health Syst Pharm
(2007)
Cited by (0)
Funding: Sanofi-aventis.
Conflict of Interest: John Fanikos, RPh, MBA serves on the Speakers Bureau for sanofi-aventis and GlaxoSmithKline and has served as a consultant/advisory board participant. Samuel Z. Goldhaber, MD, receives research funds and is a consultant for sanofi-aventis, Eisai, Bristol-Myers Squibb, and Boehringer-Ingelheim. The remaining authors have no conflicts to disclose.
Authorship: All authors had access to the data and participated in the manuscript preparation.