Patterns of non-administration of ordered doses of venous thromboembolism prophylaxis: implications for novel intervention strategies

Shermock, KM; Lau, Brandyn; Haut, Elliott R.; Hobson, Deborah B.; Ganetsky, Valerie S.; Kraus, Peggy S.; Efird, Leigh; Elder, S.; Pinto, Brian; Streiff, Michael B.

doi:10.1016/j.jval.2013.03.1509

Cited by 13 publications

(19 citation statements)

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“…These efforts were made with the implicit and incorrect assumption that prescribed medication doses will always be administered to patients, when in fact patient refusal is a leading cause of nonadministration. Studies of VTE prophylaxis administration have reported that 10% to 12% of doses are not administered to patients . Alarmingly, it has been reported that among medically ill patients, between 10% and 30% of doses are not administered, with patient refusal as the most frequently documented reason.…”

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confidence: 99%

Patient preferences regarding pharmacologic venous thromboembolism prophylaxis

Wong

Kraus

Lau

et al. 2014

Journal of Hospital Medicine

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BACKGROUND The 2012 American College of Chest Physicians venous thromboembolism prevention guidelines emphasized the importance of considering patient preferences when ordering venous thromboembolism prophylaxis. OBJECTIVE Determine patient preferences regarding pharmacologic venous thromboembolism prophylaxis. DESIGN Single‐center, mixed‐methods survey. SETTING Academic medical center. PATIENTS Consecutive hospitalized patients on surgical and medical units. MEASUREMENTS Patients were asked about their preferences regarding the route of administration for pharmacologic venous thromboembolism prophylaxis and the rationale for their preference. Qualitative analyses of themes were determined from patient rationale. RESULTS Of the 227 patients, a majority (60.4%) preferred an oral medication, if equally effective to subcutaneous options. Dislike of needles (30.0%) and pain from injection (27.7%) were identified as rationales for their preference. Patients favoring subcutaneous administration (27.5%) identified a presumed faster onset of action (40.3%) as the primary reason for their preference. Patients with a preference for subcutaneous injections were less likely to refuse prophylaxis than patients who preferred an oral route of administration (37.5% vs 51.3%, P < 0.0001). LIMITATION Only medical and surgical patients participated. CONCLUSION In a sample of consecutive medical and surgical patients, a majority preferred an oral route of administration for prophylaxis. Patients preferring subcutaneous injections were less likely to refuse doses of ordered pharmacologic prophylaxis. These results indicate use of an oral agent for venous thromboembolism prophylaxis may improve adherence and that integrating patient preferences into care may increase delivery of effective prophylaxis and reduce the incidence of venous thromboembolism. Journal of Hospital Medicine 2015;10:108–111. © 2014 Society of Hospital Medicine

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confidence: 99%

Patient preferences regarding pharmacologic venous thromboembolism prophylaxis

Wong

Kraus

Lau

et al. 2014

Journal of Hospital Medicine

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“…Nonetheless, a sensitivity analysis demonstrated that the reduction in symptomatic VTE remains valid. Another limitation of our study is that it evaluated the prescription of VTE prophylaxis but not its actual administration, which may also have an effect on efficacy of prophylaxis . Our study also had a limited number of cancer and stroke patients, and.…”

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confidence: 99%

Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events

et al. 2013

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Venous thromboembolism (VTE) affects over 700,000 Americans annually. Prophylaxis reduces the risk of VTE by 60% but many patients still do not receive risk-appropriate VTE prophylaxis. To improve our institution's VTE prophylaxis performance, we developed mandatory computerized clinical decision supportenabled "smart order sets" that required providers to assess VTE risk factors and contraindications to pharmacologic prophylaxis. Using provider responses, the order set recommends evidence-based riskappropriate VTE prophylaxis. To study the impact of our "smart order set" on prescription of risk-appropriate VTE prophylaxis and clinical outcomes, we conducted a retrospective chart review of consecutive patients admitted to the Medicine service during one month immediately prior to (November 2007) and a single month subsequent to (April 2010) order set launch. Data collection included patient demographics, VTE risk factors, and the use and type of VTE prophylaxis. The pre-and post-implementation cohorts contained 1,000 and 942 patients, respectively. After implementation of the "smart order set", the prescription of risk-appropriate VTE prophylaxis increased from 65.6% to 90.1% (P < 0.0001). Orders for any form of VTE prophylaxis increased from 76.4% to 95.6% (P < 0.0001). Radiographically documented symptomatic VTE within 90 days of hospital discharge declined from 2.5% to 0.7% (P 5 0.002). Preventable harm was completely eliminated (1.1% to 0%, P 5 0.001) with no difference in major bleeding or all-cause mortality. A VTE prophylaxis computerized clinical decision support-enabled "smart order set" improved prescription of risk-appropriate VTE prophylaxis, reduced symptomatic VTE and eliminated preventable harm from VTE without increasing major bleeding. Am. J. Hematol. 88:545-549,

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“…Akut DVT ve PE'nin tedavisi ve tekrarlayan VTE'nin önlenmesi, öncelikle antikoagülan tedavi kullanılmasını gerektirmektedir. Tedavi için güncel bakım standardı ise genellikle düşük moleküler ağırlıklı heparin ile yapılan tipik bir K vitamini antagonistidir (Fanikos et al, 2010;Shermock et al 2013). VTE'nin insidansının ve ekonomik yükünün arttığı, VTE kaynaklı mortalitenin ise tedavi maliyetlerini arttırdığı, sağlık sistemlerine ekonomik yük getirdiği ifade edilebilir (Fanikos et al, 2013).…”

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A Systematic Review of the Determination of Costs and Economic Burden of Venous Thromboembolism: LMWH as a Pharmaeconomic Preventive Therapy

Koca

Çelik

2020

İşletme Bilimi Dergisi

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Patterns of non-administration of ordered doses of venous thromboembolism prophylaxis: implications for novel intervention strategies

Abstract: A291telephone counseling can significantly improve blood pressure control. Our data show also that interventions run by allied health professionals (i.e. other than the prescriber/doctor), improve adherence to medicines and promote hypertension-related health behaviors.

Cited by 13 publications

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Patient preferences regarding pharmacologic venous thromboembolism prophylaxis

Patient preferences regarding pharmacologic venous thromboembolism prophylaxis

Impact of a venous thromboembolism prophylaxis “smart order set”: Improved compliance, fewer events

A Systematic Review of the Determination of Costs and Economic Burden of Venous Thromboembolism: LMWH as a Pharmaeconomic Preventive Therapy

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