Effect of mandatory electronic order set on the ordering of DVT prophylaxis in medical patients: a prospective and retrospective study

Excerpt

Background Though there are well-established guidelines and studies demonstrating the benefits of deep venous thrombosis (DVT) prophylaxis in preventing hospital acquired DVTs in medically ill patients, numerous studies continue to show the underutilization of DVT prophylaxis. We implemented mandatory electronic risk stratification on hospital admission for medical patients to increase the rate of DVT prophylaxis. Methods Mandatory risk stratification was installed on computerized physician order entry software beginning July 1, 2006. However, prophylaxis ordering was at physician discretion. Pre- and post-order set implementation data collected (July 1–Dec 31, 2005 vs. July 1–Dec 31, 2006) with specific inclusion/exclusion criteria. Inclusion criteria included patients with acute medical illness and length of stay ≥3 days. Exclusion criteria included an INR >1.8 or patients on full dose anticoagulation within 24 h of admission. Results The rate of DVT prophylaxis increased significantly in the 6 month period after electronic alert implementation compared to the same time period one year earlier before implementation (89.7% vs. 84%; P < 0.005). The table below shows the rates of prophylaxis and occurrence of VTE (DVT and PE) in each group after implementation compared to those receiving and not receiving prophylaxis. …