scholarly journals Electronic prescribing systems as tools to improve patient care: a learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention

2021 ◽  
Author(s):  
S. Gallier ◽  
A. Topham ◽  
P. Nightingale ◽  
M. Garrick ◽  
I. Woolhouse ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Systems Approach ◽  
Electronic Prescribing ◽  
Low Molecular Weight ◽  
Vte Prophylaxis ◽  
Face To Face ◽  
Guideline Compliance ◽  
Hospitalised Patients

AbstractBACKGROUNDVenous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance (an assessment and action) is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems(EPS) can mandate guideline-compliant actions. We hypothesised that EPS-based interventions would increase full VTE guideline compliance more than other interventions.METHODSAll admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011-2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included face-to-face feedback based on measured performance (an individual approach) and mandatory risk assessment and prescribing rules into an EPS (a systems approach).RESULTSData from all 235,005 admissions and all 5503 prescribers were included in the analysis. Face-to-face feedback improved full VTE guideline concordance from 70% to 77% (p=<0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p=<0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p<0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis.DISCUSSION/ CONCLUSIONAn EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention. Non-compliance was still not eradicated despite this mandated system and requires further research.FUNDINGHDR-UK Hub PIONEERSummary BoxWhat is already known?Hospitalised patients are at an increased risk of venous thromboembolism (VTE), which can lead to significant morbidity and mortality. Risk factors for VTE are well known, there are established screening criteria and there is an effective prophylactic therapy, using low molecular weight heparin where indicated. Since 2010, NHS England has mandated the reporting of the percentage of patients with a completed VTE risk assessment. However, it does not automatically follow that completing a risk assessment leads to the appropriate action (prescribing and administering VTE prophylaxis where indicated). Currently it is unclear what percentage of patients have a guideline compliant VTE risk assessment and an associated action, or how full guideline compliance can be improved.What does this paper add?First, this paper describes that a VTE risk assessment does not always lead to full VTE guideline compliance (an appropriate prescription and administration of heparin where indicated). This is currently not part of mandated reporting but potentially could lead to patient harm. Second, that Electronic Health Systems (EHS) can capture and interrogate guideline-associated risk assessments and prescribing, and be used to improve full guideline compliance, through a combination of individual feedback to prescribing outliers and mandated prescribing rules. These EPS-assisted systems are robust, and sustain guideline compliance through personnel and formulary changes.

scholarly journals Electronic prescribing systems as tools to improve patient care: A learning health systems approach to increase guideline concordant prescribing for venous thromboembolism prevention.

2021 ◽  
Author(s):  
Suzy Gallier ◽  
Alexander Topham ◽  
Peter Nightingale ◽  
Mark Garrick ◽  
Ian Woolhouse ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Systems Approach ◽  
Electronic Prescribing ◽  
Low Molecular Weight ◽  
Face To Face ◽  
Guideline Compliance ◽  
Over Time

Abstract BackgroundVenous thromboembolism (VTE) causes significant mortality and morbidity in hospitalised patients. Risk factors for VTE are well known and there are validated risk assessment tools to support the use of prophylactic therapies. In England, reporting the percentage of patients with a completed VTE risk assessment is mandated, but this does not include whether that risk assessment resulted in appropriate prescribing. Full guideline compliance, defined as an assessment which led to an appropriate action - here prescribing prophylactic low molecular weight heparin where indicated, is rarely reported. Education, audit and feedback enhance guideline compliance but electronic prescribing systems(EPS) can mandate guideline-compliant actions. We hypothesised that a systems-based EPS intervention (prescribing rules which mandate approval or rejection of a proposed prescription of prophylactic low molecular weight heparin based on the mandated VTE assessment) would increase full VTE guideline compliance more than interventions which focused on targeting individuals. MethodsAll admitted patients within University Hospitals Birmingham NHS Foundation Trust were included for analysis between 2011-2020. The proportion of patients who received a fully compliant risk assessment and action was assessed over time. Interventions included teaching sessions and face-to-face feedback based on measured performance (an individual approach) and mandatory risk assessment and prescribing rules into an EPS (a systems approach).RESULTSData from all 235,005 admissions and all 5503 prescribers were included in the analysis. Risk assessments were completed in >90-95% of patients at all times, but full guideline compliance was lower (70% at the start of this study). Face-to-face feedback improved full VTE guideline compliance from 70% to 77% (p=<0.001). Changes to the EPS to mandate assessment with prescribing rules increased full VTE compliance to 95% (p=<0.001). Further amendments to the EPS system to reduce erroneous VTE assessments slightly reduced full compliance to 92% (p<0.001), but this was then maintained including during changes to the low molecular weight heparin used for VTE prophylaxis. DISCUSSION/ ConclusionAn EPS-systems approach was more effective in improving sustained guideline-compliant VTE prevention over time. Non-compliance remained at 8 – 5% despite this mandated system. Further research is needed to assess the potential reasons for this.

PS-100 Venous thromboembolism (VTE) prophylaxis for hospitalised medical patients (HMP) with low molecular weight heparin (LMWH)

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A176.1-A176
Author(s):  
FI Ferreira Tátá ◽  
MA Pires Rebelo ◽  
ML Grenho Pereira ◽  
NM Ribeiro Landeira ◽  
SM Dias Fanica ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Vte Prophylaxis

Venous thromboembolism (VTE) prophylaxis

2018 ◽  
pp. 121-126
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Surgical Patients ◽  
Related Factors ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Preventable Complication ◽  
Fatal Complications

Venous thromboembolism is a common but largely preventable complication following surgery. However, fatal complications can occur as a result of pulmonary embolism following deep vein thrombosis. A structured risk assessment should be performed preoperatively in all surgical patients and thromboprophylaxis measures should be tailored according to patient- and procedure-related factors. These measures include anticoagulation with low molecular weight heparin and the use of mechanical compression devices.

scholarly journals Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital

2020 ◽  
Vol 9 (3) ◽  
pp. e000680
Author(s):  
Melanie Nana ◽  
Cherry Shute ◽  
Rhys Williams ◽  
Flora Kokwaro ◽  
Kathleen Riddick ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
General Hospital ◽  
District General Hospital ◽  
Educational Material ◽  
Standards Of Care ◽  
Vte Prophylaxis ◽  
Hospitalised Patients

Hospital-acquired venous thromboembolism (VTE) accounts for an estimated 25 000 preventable deaths per annum in the UK and is associated with significant healthcare costs. The National Institute for Health and Care Excellence guidelines on the prevention of VTE in hospitalised patients highlight the clinical and cost-effectiveness of VTE prevention strategies. A multidisciplinary quality improvement team (MD QIT) based in a district general hospital sought to improve compliance with VTE prophylaxis prescription to greater than 85% of patients within a 3-month time frame. Quality improvement methodology was adopted over three cycles of the project. Interventions included the introduction of a ‘VTE sticker’ to prompt risk assessment; educational material for medical staff and allied healthcare professionals; and patient information raising the awareness of the importance of VTE prophylaxis. Implementation of these measures resulted in significant and sustained improvements in rates of risk assessment within 24 hours of admission to hospital from 51% compliance to 94% compliance after cycle 2 of the project. Improvements were also observed in medication dose adjustment for the patient weight from 69% to 100% compliance. Dose adjustments for renal function showed similar trends with compliance with guidelines improving from 80% to 100%. These results were then replicated in a different clinical environment. In conclusion, this project exemplifies the benefits of MD QITs in terms of producing sustainable and replicable improvements in clinical practice and in relation to meeting approved standards of care for VTE risk assessment and prescription. It has been demonstrated that the use of educational material in combination with a standardised risk assessment tool, the ‘VTE sticker’, significantly improved clinical practice in the context of a general medical environment.

Prevention of Venous Thromboembolism and Pregnancy Complications using Low-Molecular-Weight Heparin during Pregnancy: A Systematic Review of Safety and Thromboprophylactic Efficacy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1781-1781
Author(s):  
Ian A. Greer ◽  
Catherine Nelson-Piercy
Keyword(s):  
Systematic Review ◽  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Side Effects ◽  
Pregnancy Complications ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Skin Reactions ◽  
Safety And Efficacy ◽  
Vte Prophylaxis

Abstract Introduction Low-molecular-weight heparin (LMWH) is used in pregnancy for venous thromboembolism (VTE) prophylaxis and for prevention of pregnancy complications, because of efficacy greater than or equal to unfractionated heparin, and a lower rate of side effects observed in non-pregnant patients. Due to the lack of data from large randomized controlled trials to guide physician’s practices, there is a need for increased data on safety and efficacy of LMWH for these indications. Our aim was to evaluate the safety and efficacy of using LMWH during pregnancy for preventing VTE and pregnancy complications by performing a systematic review of data from published literature. Methods Data from published studies on the use of LMWH during pregnancy as VTE prophylaxis or LMWH for prevention of pregnancy complications were identified by searching MEDLINE and EMBASE databases up to the end of 2003. The reference lists from identified articles were also hand searched. Data on the LMWH regime, incidence of VTE, pregnancy complications, clinical outcomes and side effects were extracted and entered into pre-piloted forms. Results Fifty studies reporting 2,322 pregnancies were included in this analysis. LMWH was received antenatally in 1883 (81%) of cases, and only peri or postpartum in 389 (17%) of cases. Dalteparin and enoxaparin were the most commonly used LMWH, but certoparin, nadroparin, rivaparin, and tinzaparin were also used. There were no maternal deaths. VTE was reported in 26 (1.1%) pregnancies. Severe maternal bleeding occurred in 46 (2%) pregnancies and was generally associated with obstetric causes. Thrombocytopenia occurred in 10 (0.4%) pregnancies and was not associated with thrombosis. Minor allergic skin reactions occurred in 23 (1%) pregnancies, and osteoporosis in two (0.09%) pregnancies. Conclusion Data from this systematic review of the literature suggest that LMWH is both safe and effective for use as VTE prophylaxis during pregnancy.

Venous Thromboembolism in Patients With Cancer

2010 ◽  
Vol 23 (4) ◽  
pp. 294-302
Author(s):  
Joanna Maudlin Pangilinan
Keyword(s):  
Venous Thromboembolism ◽  
Patient Population ◽  
Survival Benefit ◽  
Associated Factors ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Effective Management ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Complex Patient

Clinicians must always maintain a heightened suspicion for the development of venous thromboembolism (VTE) in the cancer patient population. VTE is common in this population and often results in morbidity and mortality. The pathophysiology is complex and likely multifactorial. Risk factors for VTE include patient-associated, cancer-associated, and treatment-associated factors as well as biomarkers. Low-molecular-weight heparin (LMWH) is a cornerstone for VTE prophylaxis and treatment. Studies have shown that LMWH may decrease VTE recurrence and impart a survival benefit. Organizational guidelines are available to assist the clinician in choosing appropriate anticoagulant agents, dosing, and duration of prophylaxis and treatment. Pharmacists serve an important role for the safe and effective management of anticoagulation in this complex patient population. In addition, pharmacists can be important providers of patient education about VTE and anticoagulation.

Venous thromboembolism in a general hospital. An update with low molecular weight heparin prophylaxis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 17-22
Author(s):  
Schulz ◽  
Kesselring ◽  
Seeberger ◽  
Andresen
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Hospital Stays ◽  
Event Rates

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

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