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Evaluating the appropriateness of thromboprophylaxis in an acute care setting using a computerised reminder, through order-entry system.

Pham DQ, Pham AQ, Ullah E, McFarlane SI, Payne R

Western University of Health Sciences, College of Pharmacy, Fountain Valley Regional Hospital and Medical Center, Orange County, CA, USA.

Aims: Evidence suggests that thromboprophylaxis is still significantly underutilised across the United States despite its relationship with morbidity, mortality and resource expenditure. Previous randomised trials that have incorporated computerised reminders, through order-entry systems, have resulted in increased rates of thromboprophylaxis and lower incidences of clinically diagnosed deep-vein thrombosis or pulmonary embolism. The primary purpose of this prospective, observational study is to evaluate the use and appropriateness of preset computerized thromboprophylaxis regimens for patients in a major county metropolitan hospital over a 1-month period by evaluating the proportion of patients actually receiving recommended thromboprophylaxis according to established hospital guidelines. Methods: This prospective, observational study was conducted in a large county hospital that recently established an evidence-based routine computerised policy to decrease risk of venous thromboembolism. Physicians, residents, medical interns, medical students, pharmacy students, and nurses were the targets of the investigation. Data were randomly collected between 10 internal medicine teams from 10 October 2006 to 10 November 2006. Investigators completed one DVT/PE risk assessment form for each patient reviewed and compared this to actual prescribed therapy to determine appropriateness of therapy. Results: Pharmacological or non-pharmacological thromboprophylaxis was administered to 100% of patients evaluated. Eighty-six patients received recommended DVT/PE prophylaxis based on established hospital guidelines. Discussion: Reported values seem to indicate that computerized reminders are capable of providing venous thromboprophylaxis for medically ill (non-surgical) patients relative to published norms. Conclusion: Results of this observational study reinforces the evidence that computerized, reminders, through order-entry systems might increase the delivery of thromboprophylaxis for hospitalized patients.

Published 4 January 2008 in Int J Clin Pract, 62(1): 134-7.
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