Preventing Venous Thromboembolism: Is This An Achievable Outcome Measure?

Preventing Venous Thromboembolism: Is This an Achievable Outcome Measure?

Mona Ann Beier, MD^*¹; Dr. Mangla Gulati, MD, FACP, FHM¹ and Dr. Ada Offurum, M.D.², (1)University of Maryland Medical Center, Baltimore, MD, (2)University of Maryland, Baltimore, MD

Meeting: Hospital Medicine 2016, March 6-9, San Diego, Calif.

Abstract Number: 67

Category: Research

Sub-Category: Other

Keywords:

Background:

Venous thromboembolism (VTE) is a well-known complication in patients who are hospitalized. It is a recommendation of the Joint Commission to prescribe prophylactic anticoagulation to prevent VTE, as prophylaxis is estimated to reduce the risk of VTE by 50-75%. Many hospitals are evaluated based on rates of acquired VTE, rather than if appropriate prophylaxis was received.

Methods:

We conducted a retrospective case control study of the hospital-acquired VTEs in our institution from December 2013 to August 2014 to determine if patients received appropriate prophylaxis according to risk stratification and current national guidelines. The electronic medication administration record (EMAR) was reviewed to determine if patients received all doses of prophylaxis. If patients received all doses of the appropriate prophylaxis, VTEs were classified as not preventable. If the appropriate prophylaxis was ordered, but the patient missed any doses; VTEs were classified as potentially preventable. If the appropriate prophylaxis was not ordered, VTEs were classified as preventable.

Results: There were a total of 56 hospital-acquired VTEs, in which 30.4% were classified as not preventable, 48.2% potentially preventable, and 21.4% were preventable. Notably, 29.4% of patients with VTEs that were not preventable were receiving full-dose anticoagulation. Of those patients with potentially preventable VTEs, the most common reasons for missed doses included active bleeding (42%), patient refusal (23%) and undergoing procedure/surgery (15%).

Conclusions:

The majority of patients with hospital-acquired VTEs received appropriate prophylaxis or documented reasons for holding prophylaxis based on recommendations in National guidelines. Penalty should be shifted to reflect a process measure of if appropriate prophylaxis was ordered rather than outcome measure of VTE until more effective prophylaxis is determined.