Pham D Q, Pham A Q, Ullah E, McFarlane S I, Payne R
Western University of Health Sciences, College of Pharmacy, Fountain Valley Regional Hospital and Medical Center, Orange County, Pomona, CA 91766-1854, USA.
Int J Clin Pract. 2008 Jan;62(1):134-7. doi: 10.1111/j.1742-1241.2007.01578.x. Epub 2007 Sep 24.
Evidence suggests that thromboprophylaxis is still significantly underutilised across the United States despite its relationship with morbidity, mortality and resource expenditure. Previous randomised trials that have incorporated computerised reminders, through order-entry systems, have resulted in increased rates of thromboprophylaxis and lower incidences of clinically diagnosed deep-vein thrombosis or pulmonary embolism. The primary purpose of this prospective, observational study is to evaluate the use and appropriateness of preset computerized thromboprophylaxis regimens for patients in a major county metropolitan hospital over a 1-month period by evaluating the proportion of patients actually receiving recommended thromboprophylaxis according to established hospital guidelines.
This prospective, observational study was conducted in a large county hospital that recently established an evidence-based routine computerised policy to decrease risk of venous thromboembolism. Physicians, residents, medical interns, medical students, pharmacy students, and nurses were the targets of the investigation. Data were randomly collected between 10 internal medicine teams from 10 October 2006 to 10 November 2006. Investigators completed one DVT/PE risk assessment form for each patient reviewed and compared this to actual prescribed therapy to determine appropriateness of therapy.
Pharmacological or non-pharmacological thromboprophylaxis was administered to 100% of patients evaluated. Eighty-six patients received recommended DVT/PE prophylaxis based on established hospital guidelines.
Reported values seem to indicate that computerized reminders are capable of providing venous thromboprophylaxis for medically ill (non-surgical) patients relative to published norms.
Results of this observational study reinforces the evidence that computerized, reminders, through order-entry systems might increase the delivery of thromboprophylaxis for hospitalized patients.
有证据表明，尽管血栓预防与发病率、死亡率及资源消耗相关，但在美国其使用仍明显不足。以往通过医嘱录入系统纳入计算机化提醒的随机试验，已使血栓预防率提高，临床诊断的深静脉血栓形成或肺栓塞发病率降低。这项前瞻性观察性研究的主要目的是，通过评估在一家大型县级城市医院中，按照既定医院指南实际接受推荐血栓预防措施的患者比例，来评价预设的计算机化血栓预防方案在1个月期间对患者的使用情况及适用性。
这项前瞻性观察性研究在一家大型县级医院开展，该医院最近制定了一项基于证据的常规计算机化政策以降低静脉血栓栓塞风险。调查对象包括医生、住院医师、实习医生、医学生、药学专业学生和护士。于2006年10月10日至2006年11月10日期间，从10个内科团队中随机收集数据。调查人员为每位接受评估的患者填写一份深静脉血栓形成/肺栓塞风险评估表，并将其与实际开具的治疗方案进行比较，以确定治疗的适用性。
所有接受评估的患者均接受了药物或非药物血栓预防措施。86名患者根据既定医院指南接受了推荐的深静脉血栓形成/肺栓塞预防措施。
报告的数据似乎表明，相对于已发表的规范，计算机化提醒能够为内科疾病（非手术）患者提供静脉血栓预防。
这项观察性研究的结果进一步证明，通过医嘱录入系统的计算机化提醒可能会增加住院患者的血栓预防措施实施率。
