Key result
Embedded Padua Prediction Score calculators fail to prevent inappropriate thromboprophylaxis in ~36% of hospitalized veterans.
Why the study?
Hospitalized patients have an increased risk of venous thromboembolism, and this study assessed whether the Padua Prediction Score embedded in an admission order set was utilized appropriately to guide pharmacologic thromboprophylaxis.
Cohort (n=250)
No
Embedding the Padua Prediction Score in admission order sets is insufficient to ensure appropriate VTE prophylaxis prescribing, highlighting the need for additional clinical decision support tools.
Answers are grounded in this paper and cite their sources.
Persistent inappropriate VTE prophylaxis despite embedded scoring; leaves open whether supplementary decision support improves adherence in veterans.
Background: Hospitalized patients are at increased risk of developing venous thromboembolism (VTE). The Padua Prediction Score (PPS) was developed to help quantify the risk of VTE for hospitalized patients and guide prescribing of pharmacologic thromboprophylaxis. This study aims to assess whether PPS embedded within an admission order set was utilized appropriately to prescribe or withhold pharmacologic thromboprophylaxis. Methods: This single center, retrospective observational cohort study evaluated adult patients aged ≥ 18 years between June 2017 and June 2020. A random sample of 250 patient charts meeting inclusion criteria were reviewed to calculate PPSs, and clinician notes were reviewed for documentation as to whether thromboprophylaxis was given or withheld appropriately based on the PPS. A second cohort of patients admitted within the study period meeting inclusion criteria and readmitted for VTE within 45 days of discharge were evaluated to determine appropriateness of inpatient VTE thromboprophylaxis during index hospitalization based on the PPS. Results: Of the 250 patients examined, 118 (47.2%) had a PPS < 4 on admission. Of the 118 patients, 58 (49.2%) were inappropriately prescribed pharmacologic thromboprophylaxis administered within 24 hours of admission. The clinical rationale for giving thromboprophylaxis when not indicated was provided for only 2 (3.4%) of the 58 patients. Of the 132 patients with a PPS ≥ 4, 11 (8.3%) had thromboprophylaxis appropriately withheld and for 33 (25.0%) it was inappropriately withheld. A total of 88 (66.7%) patients received thromboprophylaxis as indicated by a PPS ≥ 4. Conclusions: Despite the inclusion of the PPS calculator in the facility's admission order set, this study showed pharmacologic thromboprophylaxis was frequently inappropriately given or withheld. This suggests written protocols and order sets may not be solely sufficient to ensure appropriate VTE prophylaxis in actual practice. Incorporation of additional tools, such as dashboards and scorecards, should be explored.
No takes yet. Share an insight, caveat, or question.
Bianca Creith (2022) conducted a cohort in Venous thromboembolism risk in hospitalized patients (n=250). Padua Prediction Score (PPS) embedded within an admission order set was evaluated on Percentage of patients for whom pharmacologic thromboprophylaxis was appropriately initiated or withheld based on a PPS calculated upon admission. Despite the inclusion of a Padua Prediction Score calculator in the admission order set, pharmacologic thromboprophylaxis was inappropriately given or withheld in 36.4% of hospitalized veterans.
Synapse has enriched 10 related papers. Consider them for comparative context: