IMPACT OF A COMPUTERIZED PROTOCOL ON THROMBOPROPHYLAXIS USE IN GENERAL SURGERY: STUDY DESIGN GAMBACORTA, J.,1,2 HORÁK, P.,3,4 VLČEK, J.1,5 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové,
Charles University, Czech Republic
2 University Hospital in Motol, Prague, Czech Republic
3 First Faculty of Medicine, Prague, Charles University, Czech Republic 4 Hospital Na Bulovce, Prague, Czech Republic
5 University Hospital in Hradec Králové, Czech Republic
e-mail: gambacorta@faf.cuni.cz
A large proportion of hospitalized patients are at risk for venous thromboembolism (VTE), but there is a low rate of appropriate prophylaxis in clinical practice.1 According to the American College of Chest Physicians (ACCP) guidelines, all hospitalized patients admitted in a surgical ward should be assessed for the risk of VTE.2 Various strategies to improve the use of thromboprophylaxis have been recommended including the computerized systems.3 To our knowledge, there is no protocol standardization or any other active strategy leading to the appropriate thromboprophylaxis in surgical patients described in the Czech literature. In the past, there was also a lack of standardization in prescribing thromboprophylaxis to the surgical patients in our hospital. Therefore we decided to create and implement the VTE prophylaxis computerized protocol (VTEP-CP) as a decision support tool for physicians. After the protocol has been routinely used by physicians for several years, we decided to analyze the rate of compliance with the guidelines on VTE prophylaxis and to determine the incidence of VTE and major bleeding before and after implementation of VTEP-CP. The list of patients admitted in the surgical ward that underwent elective general surgery was provided through the hospital information system for a period of eleven months in 2012 (group A = before VTEP-CP implementation) and eleven months in 2014 (group B = before VTEP-CP implementation). We were able to obtain some of the required data of the patients in electronic form directly from the hospital information system and thus create a baseline database that we must now complete with the data from the patient medical records. Patients in group A are scored by the VTEP-CP using the data from the hospital admission form. For group B, the data from the VTEP-CP are used and also medical records are reviewed. The risk score, the dose and type of LMWH recommended by the VTEP-CP, the dose and type of LMWH administered to the patient and usage of mechanical prophylaxis is registered for both groups. We also review the documentation of patients for the diagnosis of VTE and signs or diagnosis of major bleeding. In the presentation, we will discuss the study design, its limitations, and the possible benefit of the research in the field of clinical pharmacy. The study was supported by Research programme Development and Study of Drugs (Progres Q42) and from the project of Specific Academic Research (SVV 260 417/2019) .
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