Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital

PURPOSE: The implementation of a pharmacist-led program to improve venous thromboembolism (VTE) prophylaxis is examined. SUMMARY: Nursing and pharmacy leaders at a 278-bed hospital reviewed VTE prophylaxis. The review revealed that among the total patient days for a month (excluding maternity, nursery, pediatric, and psychiatry patient days), prophylaxis was administered on only 19.5% of those days. Pharmacy leadership viewed this as an opportunity to make hospitalwide improvements and offered to develop a pharmacist-led program to assess all new admissions for risk of VTE and to recommend appropriate pharmacologic prophylaxis. Under the new program, a pharmacist receives a daily report of all new admissions, which are cross-referenced with a report including patients currently prescribed heparin or low-molecular-weight heparin. Maternity, nursery, pediatric, and psychiatry patients are identified and excluded. The pharmacist assesses the remaining patients for VTE risk using a tracking sheet. The pharmacist then places all recommendations in the progress notes of the chart in the form of a bold sticker alerting the physician of known risk factors, VTE risk, and treatment recommendations. The program was developed to be performed seven days a week and maintained by one pharmacist per day for an average of four hours a day. Evaluation of the program three and six months after its implementation revealed marked increases in the use of prophylaxis and associated reductions in the occurrence of deep venous thrombosis (DVT) confirmed by Doppler ultrasonography. CONCLUSION: A pharmacist-led program for VTE prevention was associated with a significant increase in the prescribing of VTE prophylaxis and a significant reduction in ultrasonographically confirmed DVT.