Background
Venous thromboembolism events are potentially preventable adverse events. We investigated
the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism
incidence. Additionally, we evaluated the utility of electronic medical record alerts
for venous thromboembolism prophylaxis.
Methods
Venous thromboembolisms were identified in surgical patients retrospectively through
Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November
2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber
response to electronic medical record alerts were recorded prospectively. Prophylaxis
was categorized as continuous, delayed, interrupted, other, and none.
Results
Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of
the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis,
length of stay, age, and transfer from another hospital were associated with increased
venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions
were associated with 3 times greater odds of venous thromboembolism. Delays were associated
with 2 times greater odds of venous thromboembolism. Electronic medical record alerts
occurred in 45.7% of the encounters and were associated with a 2-fold increased venous
thromboembolism incidence. Focus groups revealed procedures as the main contributor
to interruptions, and workflow disruption as the main limitation of the electronic
medical record alerts.
Conclusion
Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism
prophylaxis and optimization of electronic medical record tools for prophylaxis may
help decrease rates of preventable venous thromboembolism.
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Article info
Publication history
Published online: June 16, 2016
Accepted:
April 13,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
