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A facility mandate for pharmacist assessment improves venous thromboembolism outcomes
Author(s) -
Cole Jennifer L.,
Stark Jennifer E.
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1067
Subject(s) - medicine , veterans affairs , pharmacist , incidence (geometry) , pharmacy , odds ratio , emergency medicine , confidence interval , medical record , retrospective cohort study , clinical pharmacy , risk assessment , venous thromboembolism , electronic medical record , intensive care medicine , family medicine , thrombosis , physics , computer security , computer science , optics
Background Narrowing the implementation gap for prophylaxis of venous thromboembolism (VTE) continues to be a challenge for many health care facilities. A primary Veterans Affairs (VA) facility implemented a new mandate for pharmacy assessment of VTE risk factors in acute care patients with required documentation in the permanent medical record using a novel electronic note and template. The purpose of this study was to evaluate the effect of this innovative intervention on VTE outcomes. Methods Beginning in January 2014, a clinical pharmacist reviewed hospitalized patient profiles within 48 hours of admission at the study facility. Risk factors for VTE were identified and the presence or absence of appropriate pharmacologic prophylaxis was documented in an electronic note. If pharmacologic prophylaxis was indicated but not given, the provider was added to the note as a required additional signer. This was a retrospective review of aggregated data from October 2008 to June 2018. The primary outcome was incidence of VTE events before and after the 2014 intervention. Secondary outcomes included 30‐day readmissions for VTE and percentage of high‐risk patients with VTE prophylaxis present. Results There were a total of 36 474 discharges encompassed in the study period; 23 202 before and 13 272 after the 2014 required pharmacist assessment. The incidence of VTE decreased from 0.20% to 0.11% (odds ratio [OR] 1.90; confidence interval [CI] 1.04‐3.46, P = 0.039). The incidence of 30‐day readmissions for VTE also decreased from 0.16% to 0.04% (OR 4.12; CI 1.67‐10.19, P = 0.001). High‐risk diagnoses had a similar rate of pharmacologic prophylaxis (82% vs 86%; P = 0.31). Conclusion A facility mandate for pharmacy assessment of VTE risk factors with the development of a novel electronic note and required documentation in the medical record decreased preventable VTE events.