TY - JOUR
T1 - Implementation of a pharmacological prophylaxis bundle to prevent obstetric-associated venous thromboembolism
AU - Iverson, Ronald E.
AU - Zhang, Min
AU - Jansen, Emily M.
AU - Trucks, Emma
AU - Iorio, Rhiannon
AU - Combs, Ginny
AU - Kourtelidis, Marie
AU - Mottl-Santiago, Julie
AU - Norris, Mark
AU - Lambert, Lynne
AU - Katzmark, Rachel
AU - Vyas, Pooja
AU - Abbott, Jodi F.
N1 - Publisher Copyright:
© 2023 Oxford University Press. All rights reserved.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - purpose: Venous thromboembolism (VTE) accounts for a significant proportion of pregnancy-related mortality. In response to a series of VTEs at our institution and in accordance with mounting medical evidence for increased assessment, we implemented a universal, standardized obstetric VTE risk assessment process during antepartum and postpartum admissions and corresponding pharmacological thromboprophylaxis, which extends into the postdischarge period to prevent pregnancy-associated VTE in our urban, safety-net population. Summary: This quality improvement (QI) project used the Institute for Healthcare Improvement’s Model for Improvement. We analyzed data from chart audits, patient and pharmacy outreach, and electronic reports using statistical process control charts. A review of 407 charts showed an increase in the proportion of patients undergoing documented risk assessment from 0% to 80% (average of 61%) from July 2015 to June 2016. The average risk assessment rate increased from 61% to 98% from July 2016 through March 2021 after the screening was integrated into the electronic health record (EHR). Rate of receipt of recommended thromboprophylaxis during admission increased from an average of 85% before EHR integration to 94% after integration. The proportion of high-risk patients receiving prescriptions upon discharge increased from 7% before EHR integration to 87% after integration. We interviewed 117 patients by telephone, of whom 74% continued the medications at home. Conclusion: An interprofessional team can achieve high rates of obstetric inpatient VTE risk assessment, pharmacological thromboprophylaxis initiation, and outpatient continuation using QI methodology.
AB - purpose: Venous thromboembolism (VTE) accounts for a significant proportion of pregnancy-related mortality. In response to a series of VTEs at our institution and in accordance with mounting medical evidence for increased assessment, we implemented a universal, standardized obstetric VTE risk assessment process during antepartum and postpartum admissions and corresponding pharmacological thromboprophylaxis, which extends into the postdischarge period to prevent pregnancy-associated VTE in our urban, safety-net population. Summary: This quality improvement (QI) project used the Institute for Healthcare Improvement’s Model for Improvement. We analyzed data from chart audits, patient and pharmacy outreach, and electronic reports using statistical process control charts. A review of 407 charts showed an increase in the proportion of patients undergoing documented risk assessment from 0% to 80% (average of 61%) from July 2015 to June 2016. The average risk assessment rate increased from 61% to 98% from July 2016 through March 2021 after the screening was integrated into the electronic health record (EHR). Rate of receipt of recommended thromboprophylaxis during admission increased from an average of 85% before EHR integration to 94% after integration. The proportion of high-risk patients receiving prescriptions upon discharge increased from 7% before EHR integration to 87% after integration. We interviewed 117 patients by telephone, of whom 74% continued the medications at home. Conclusion: An interprofessional team can achieve high rates of obstetric inpatient VTE risk assessment, pharmacological thromboprophylaxis initiation, and outpatient continuation using QI methodology.
KW - low-molecular-weight heparin
KW - obstetrics
KW - quality improvement
KW - thromboembolism prophylaxis
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U2 - 10.1093/ajhp/zxac308
DO - 10.1093/ajhp/zxac308
M3 - Article
C2 - 36264668
AN - SCOPUS:85148479204
SN - 1079-2082
VL - 80
SP - 296
EP - 303
JO - American Journal of Health-System Pharmacy
JF - American Journal of Health-System Pharmacy
IS - 5
ER -