Loh Samantha, Wijaya Kimberly, Rogers Michelle, Asghari-Jafarabadi Mohammad, Wojnar Robert
Pharmacy Department, Cabrini Health, 183 Wattletree Road Malvern, Malvern, VIC, 3144, Australia.
Cabrini Research, Cabrini Health, Malvern, VIC, Australia.
Int J Clin Pharm. 2025 Jun;47(3):699-707. doi: 10.1007/s11096-024-01857-0. Epub 2025 Jan 7.
Despite various interventions to improve best-practice venous thromboembolism (VTE) prevention measures within hospitals, compliance remains poor. For health services utilising electronic medication management systems (eMMS), implementation of clinical decision support (CDS) tools could address this gap.
To evaluate whether local implementation of an integrated electronic alert system linked with a computerised physician order entry (CPOE)-based order set for VTE risk assessment within an eMMS improves the rates of timely VTE risk assessment and guideline-compliant VTE prophylaxis prescribing among hospitalised patients.
A retrospective observational study conducted among hospitalised patients pre- and post-implementation of an electronic alert system combined with a CPOE-based order set to prompt VTE risk assessment documentation and VTE prophylaxis prescribing within a single tertiary hospital. Admissions were consecutively screened over 7-day periods before and after implementation for inclusion and assessed for compliance with a local VTE prevention protocol.
Eight hundred and fifty patients (458 pre-intervention, 392 post-intervention) were included for evaluation. Rates of VTE risk assessment documentation within 24 h of admission increased by 29.9% (p < 0.001). Guideline-compliant VTE prophylaxis improved by 10.4% (p < 0.001). Patients with completed VTE risk assessments were significantly more likely to receive guideline-compliant VTE prophylaxis, compared to patients without documented VTE risk assessments (19.3% difference, p < 0.001). After adjusting for demographic differences, the odds of achieving positive outcomes significantly increased across all measures, with adjusted odds ratios ranging from 1.95 to 4.89 (p < 0.001).
Local implementation of CDS featuring CPOE within the eMMS improved rates of VTE risk assessment documentation and guideline-compliant VTE prophylaxis prescribing.
尽管采取了各种干预措施来改善医院内最佳实践静脉血栓栓塞症（VTE）预防措施，但依从性仍然很差。对于使用电子药物管理系统（eMMS）的医疗服务机构，实施临床决策支持（CDS）工具可以弥补这一差距。
评估在eMMS中本地实施与基于计算机化医师医嘱录入（CPOE）的VTE风险评估医嘱集相关联的综合电子警报系统，是否能提高住院患者及时进行VTE风险评估的比率以及符合指南的VTE预防处方开具率。
在一家三级医院对实施电子警报系统与基于CPOE的医嘱集前后的住院患者进行回顾性观察研究，该系统用于提示VTE风险评估记录和VTE预防处方开具。在实施前后连续7天对入院患者进行筛查以纳入研究，并评估其对当地VTE预防方案的依从性。
共纳入850例患者（干预前458例，干预后392例）进行评估。入院后24小时内VTE风险评估记录率提高了29.9%（p<0.001）。符合指南的VTE预防措施改善了10.4%（p<0.001）。与未记录VTE风险评估的患者相比，完成VTE风险评估的患者更有可能接受符合指南的VTE预防措施（差异为19.3%，p<0.001）。在调整人口统计学差异后，所有指标实现积极结果的几率均显著增加，调整后的优势比范围为1.95至4.89（p<0.001）。
在eMMS中本地实施以CPOE为特色 的CDS提高了VTE风险评估记录率和符合指南的VTE预防处方开具率。
