Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients

Abstract

Objective: The American College of Chest Physicians (ACCP) recommends unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for prevention of venous thromboembolism (VTE) in medically ill patients. Despite these recommendations, a previous analysis at our institution revealed a low utilization of VTE prophylaxis in medically ill patients. Our objective was to evaluate the effects of a pharmacy-driven education program on the quantity and quality of VTE prophylaxis in medically ill patients.

Methods: An educational program focusing on the importance of VTE prophylaxis in medically ill patients was developed by clinical pharmacists and presented to nurses, pharmacists, and physicians in a 493-bed community teaching hospital. The educational program was conducted between June 2002 and June 2003 and consisted of in-service presentations, newsletters, and quality assurance presentations on VTE prophylaxis. The educational program focused on 4 main points: (1) hospitalized medically ill patients are at risk for developing VTE, (2) how to identify medically ill patients who require VTE prophylaxis, (3) the fact that VTE prophylaxis is currently underutilized in medically ill patients, and (4) appropriate VTE prophylaxis strategies for medically ill patients. A posteducation retrospective chart review was performed in medically ill patients with discharge dates between October 2003 and March 2004, and these posteducation medical chart data were compared with the results from a preeducation analysis of patents with discharge dates from January 2001 to March 2002. Data collection included patient demographics, VTE risk factors, and use and type of VTE prophylaxis.

Results: The posteducation retrospective chart review was performed for 297 medically ill patients with discharge dates between October 2003 and March 2004 and for 344 preeducation patients discharged between January 2001 and March 2002. Patient demographics and primary diagnoses were similar between the preeducation and posteducatin groups. The mean number of risk factors per patient in the preeducation group was 2.53 +/- 0.96 versus 2.38 +/- 0.88 in the posteducation group (P=0.626). Pharmacy education was associated with an increase in the utilization of any VTE prophylaxis (43% in the preperiod vs. 58% in the postperiod; P <0.001). Prophylaxis judged to be suitable (UFH 5,000 units twice daily, or UFH 5,000 units 3 times daily, or LMWH once daily), increased from 38% in the preeducation period to 49% in the posteducation period, P=0.006). Prophylaxis judged to be optimal (UFH 3 times daily or LMWH once daily) increased from 11% to 44% of patients, P <0.001).

Conclusions: A hospital-wide clinical pharmacy education program was associated with significant improvement in the quantity and quality of VTE prophylaxis in medically ill patients in a community teaching hospital.