Advertisement

International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 1007–1013 | Cite as

Improved venous thromboembolism prophylaxis by pharmacist-driven interventions in acutely ill medical patients in Belgium

  • Audrey VervackeEmail author
  • Sophie Lorent
  • Serge Motte
Research Article

Abstract

Background Forty to 50 % of hospitalized patients with an acute medical illness have risk factors for venous thromboembolism (VTE) and it has been shown that VTE prophylaxis reduced the incidence of VTE events in these patients. However, a large multinational survey, the ENDORSE study, showed that only 37 % of medical patients with VTE risk factors actually received VTE prophylaxis. Objective To evaluate the impact over time of pharmacist-driven interventions aiming at increasing the appropriate use of VTE prophylaxis in acutely ill medical hospitalized patients. Setting A Belgian urban academic hospital. Method First, during 1 month, medical and nurse reports of all hospitalized medical patients were reviewed to evaluate the proportion of patients who were on prophylaxis according to clinical practice guidelines. Second, interventions were conducted and included unit-specific physician and nurse education, diffusion of educational tools summarizing VTE prophylaxis guidelines, and reminders. Third, the impact of the interventions on the proportion of patients receiving VTE prophylaxis according to clinical practice guidelines was evaluated after 3 months and 1 year. Main outcome measure Proportion of hospitalized medical patients receiving VTE prophylaxis according to clinical practice guidelines. Results The baseline evaluation showed that 36 % (26/72) of the patients at risk of VTE received VTE prophylaxis according to clinical practice guidelines. Three months and one year after the interventions, 68 % (55/81), and 72 % (58/81) of the patients at risk of VTE received VTE prophylaxis according to clinical practice guidelines. Among patients not at risk of VTE, 15 % (21/141), 8 % (24/290), and 8 % (27/330) respectively at baseline evaluation, 3 months and 1 year after the interventions, received VTE prophylaxis. Conclusion Pharmacist-driven interventions improved the proportion of acutely ill medical patients receiving VTE prophylaxis according to clinical practice guidelines and the benefit of the interventions was maintained after 1 year.

Keywords

Acutely ill medical patient Belgium Pharmacist Qualitative research Venous thromboembolism VTE prophylaxis 

Notes

Acknowledgments

The authors would like to thank the hospital staff that participed in this study.

Funding

None.

Conflicts of interest

None to declare.

References

  1. 1.
    Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387–94.PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson FA Jr, Zayaruzny M, Heit JA, Fidan D, Cohen AT. Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol. 2007;82:777–82.PubMedCrossRefGoogle Scholar
  3. 3.
    Alikhan R, Peters F, Wilmott R, Cohen AT. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol. 2004;57(12):1254–7.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med. 1989;82(4):203–5.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Baglin TP, White K, Charles A. Fatal pulmonary embolism in hospitalised medical patients. J Clin Pathol. 1997;50:609–10.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ. 1991;302:709–11.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Dentali F, et al. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146(4):278–88.PubMedCrossRefGoogle Scholar
  8. 8.
    Schädlich PK, Kentsch M, Weber M, et al. Cost effectiveness of enoxaparin as prophylaxis against venous thromboembolic complications in acutely ill medical inpatients: modelling study from the hospital perspective in Germany. Pharmacoeconomics. 2006;24(6):571–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals’ compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. 2007;1:69–76.CrossRefGoogle Scholar
  10. 10.
    Gould M, Garcia D, Wren S, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence based clinical practice guidelines. Chest. 2012;141(2_suppl):e227S–77S.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Falck-Ytter Y, Francis C, Johanson N, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2_suppl):e278S–325S.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S–453S.PubMedCrossRefGoogle Scholar
  13. 13.
    Hull RD, Schellong SM, Tapson VF, Monreal M, Samama MM, Nicol P, Vicaut E, Turpie AG, Yusen RD. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility: a randomized trial. Ann Intern Med. 2010;153:8–18.Google Scholar
  14. 14.
    Dobesh P, Phillips K, Haines S. Improving the use of anticoagulant therapies in acutely ill medical patients. Am J Health Syst Pharm. 2008;65(suppl 7):s5–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Bauer J, Chun D, Karpinski T. Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital. Am J Health Syst Pharm. 2008;65:1643–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Khalili H, et al. Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacist’s intervention study. Pharm World Sci. 2010;32:594–600.PubMedCrossRefGoogle Scholar
  17. 17.
    Semchuk W, Kolodziejak L, Bubbar C, Poulin S. Working toward a system-wide venous thromboembolism prophylaxis strategy: experience from a multisite health region. Hosp Pharm. 2011;46(8):574–9.CrossRefGoogle Scholar
  18. 18.
    Sobieraj D. Development and implementation of a program to assess medical patients’ need for venous thromboembolism prophylaxis. Am J Health syst Pharm. 2008;65:1755–61.PubMedCrossRefGoogle Scholar
  19. 19.
    Nendaz MR, Chopard P, Lovis C, Kucher N, Asmis LM, Dörffler J, Spirk D, Bounameaux H. Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems. J Thromb Haemost. 2010;8(6):1230–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Chopard P, Dörffler-Melly J, Hess U, Wuillemin WA, Hayoz D, Gallino A, Bachli EB, Canova CR, Isenegger J, Rubino R, Bounameaux H. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med. 2005;257(4):352–7.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  1. 1.PharmacyErasme University HospitalBrusselsBelgium
  2. 2.Health Economics Research Centre, Management of Institutions of Care and Nursing Research, School of Public Health and Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium

Personalised recommendations