A Strategy to Improve Provider Use of Deep‐Venous Thrombosis Prophylaxis

Background:

Health care organizations have had significant difficulty getting providers to prescribe deep venous thrombosis (DVT) prophylaxis for their patients. Organizations including the Joint Commission on Accreditation of Healthcare Organizations and the Agency for Health Care Research and Quality have begun mandating health care organizations to maintain quality standards in relation to DVT prophylaxis. It has been suggested that these standards will be used to guide future Medicare reimbursement. Despite the best of intentions, a 2002 analysis of our institution's use of DVT prophylaxis found a compliance rate of 50%.

Purpose:

The goal of the study was to develop a cost‐effective strategy to improve institutional compliance with prescribing DVT prophylaxis.

Description:

The hospital has 220 beds and supports a multispecialty academic group practice. A multidisciplinary study group was formed in 2003 and met through 2004. A hospital approach to DVT prophylaxis was created and standardized. Orders are entered by traditional paper methods. Using a process similar to that designed for computerized order entry systems, the group mandated a standardized DVT “order set box” be included on every hospital order set. In addition, education on the use of the order set box and the need for DVT prophylaxis was provided to the nursing and medical staffs.

Conclusions:

Our implementation improved DVT compliance rates from 50% at baseline to 97% within 12 months. These improvements have been sustained since then without any ongoing intervention. This outcome was similar to that seen in studies that combined programs prompting providers to prescribe DVT prophylaxis with staff education. For example, a study by Levi and associates in 1998 found that staff education along with DVT order sets was more effective than DVT order sets alone. The challenge in this situation was to create an order set in a traditional physician paper‐based ordering environment. Important considerations in this situation include ensuring that the order set box is well defined and easy to identify. In addition, it is important to include the box on every admission order set, both medical and surgical.

Author Disclosure:

K. Mishark, None; Z. Hartsell, None.