Purpose Venous thromboembolism (VTE) is a disease that includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE accounts for more than 250,000 hospitalizations annually in the United States and may be the most common preventable cause of death in hospitalized patients (Kim, 2001). PE is a complication of DVT, and approximately 25 to 30% of untreated patients with proximal DVT will develop symptomatic PE (Geerts, 2004). In hospitalized medical patients, up to 1 in 20 patients will suffer a fatal PE (Baglin, 1997). Based on the infrequent use of thromboprophylaxis, some authors have speculated that physician awareness and recognition of patient risk factors for VTE could be improved.
Experimental Design and Methods All patients admitted to the general internal medicine inpatient service over a 12-week period from Sunday 7 am to Friday 7 am were included in the study. Four inpatient medicine teams rotate every 24 hours for admissions. Two teams were designated as “interventional” and two teams as “control.” For the patients admitted to the two teams assigned to the intervention group, electronic medical records were queried by the pharmacy staff the morning after admission and the history and physical examination note identified. The admission history and physical examination note was then used and to determine the patient's risk for DVT. The medium- to high-risk patients were then pointed out to the physician. The physician was then left to decide whether or not to institute DVT prophylaxis. IfIf pharmacologic prophylaxis was an option, they were left to decide which evidence-based therapy would be administered. TThe primary goal of the study was the appropriate administration of DVT prophylaxis within 30 hours of the patient's hospital admission.
Summary of Results The study is currently in its last stage and has 149 patients in the interventional group and 161 in the control group. Interim analysis of randomly selected subject records showed that appropriate DVT prophylaxis rates in the control group were 8 of 15 or 53% and 13 of 15 or 86% in the interventional group.
Conclusions Preliminary data suggest that the pharmacy-driven DVT prophylaxis initiative, as outlined in the study, is an effective and feasible tool for increasing DVT prophylaxis rates among general internal medicine inpatients. This may be an effective tool that can increase compliance with JCAHO standards for an effective DVT prophylaxis inpatient program.
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