Preprinted risk assessment and prophylaxis order form for venous thromboembolism

Thromboembolic events such as pulmonary embolism and deep-vein thrombosis represent a significant risk for premature death among hospitalized patients.1 Because of the often silent nature of their occurrence, many cases go undiagnosed.2 Likewise, the economic burden of venous thromboembolism (VTE) among those who survive is also significant.3,4 The benefit of pharmacologic prophylaxis with low-dose unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) for hospitalized surgical and medical patients in prevention of VTE is well established.5,–7 The American College of Chest Physicians (ACCP) has recommended prophylaxis of medical inpatients with established risk factors for VTE since 2001.8 Nevertheless, many patients with risks for VTE remain unprotected.9 Creighton University Medical Center (CUMC) is a 348-bed, for-profit, university-affiliated, level-one trauma center. The family medicine department, with its five community clinics, 17 medical faculty, and 22 medical residents, admits approximately 105 adult patients per month to its inpatient service within CUMC. A recent informal audit of admissions found an unacceptably high number of admissions without any measure of VTE prophylaxis and an alarmingly higher number of patients not receiving prophylaxis in accordance with ACCP guidelines.