A multifaceted prevention program, including pre- and post-surgical electronic reminders to physicians, helped slash the rates of deep vein thromboses and pulmonary emboli.
According to data published in the Journal of the American College of Surgeons, researchers at Boston Medical Center reported that they lowered the frequency of deep venous thromboses by 84 percent two years after the prevention efforts began, compared with the results two years before the program. The occurrence of pulmonary emboli fell by 55 percent in the same period, according to study authors.
Initially, there was an emphasis on early postoperative mobilization--getting patients up and walking three times a day, starting on the day of the operation when possible. The program later included these additional components:
*Standardized risk assessment using five categories of venous thromboembolism risk based on scores of 0 (lowest risk) to more than 8 (highest risk).
*Individualized, risk-based prophylaxis involving inflatable pressure boots and/or low doses of anticoagulation medications.
*Electronic physician orders that specified early mobilization, the requirement to score the patients VTE risk, and the score-based appropriate preventive treatment along with the suggested duration of prophylaxis in the hospital and, for high-risk patients, continuing at home.
*Patient education to explain the importance of preventing blood clots.
Surgeons and their teams received mandatory electronic reminders regarding VTE prophylaxis before and after the operation and when the patient was discharged from the hospital. They could choose to opt out of the recommendation for preventive medication but needed to specify why. The researchers monitored the level of adherence to the automated recommendations.
Surgeons adherence to ordering the recommended prophylaxis was high. Compliance rates ranged from 100 percent for patients at low or moderate risk for a VTE to 77 percent for patients in the highest risk category. Even when patients at highest risk did not receive prevention in accordance with the recommended measures, the electronic records contained an explanation for not using blood thinners (i.e., drug allergy, active bleeding, risk of hemorrhage outweighing risk of VTE).
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