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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Impact of a Clinical Decision-Support Tool on Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients
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Impact of a Clinical Decision-Support Tool on Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients

机译：临床决策支持工具对急性医疗患者静脉血栓栓塞栓塞的影响

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Background: Adherence to guideline-based venous thromboembolism (VTE) prophylaxis recommendations is often inadequate. Effective improvement strategies are needed. Objective: The purpose of this quality improvement initiative was to increase use of the facility's preferred pharmacologic VTE prophylaxis, reduce unnecessary VTE prophylaxis use, and reduce use of pharmacologic VTE prophylaxis in high bleeding risk patients, in accordance with guideline-based recommendations. Methods: Clinical pharmacists spearheaded the development and implementation of a clinical decision-support tool (CDST) integrated within a Veterans Health Administration electronic health record (EHR). The CDST focused on VTE prophylaxis in acutely ill medical patients and guided prescribers to guideline-based recommendations. Following review and approval, the CDST underwent activation in the EHR. A subsequent intervention occurred, year 2 post-intervention, which embedded this CDST into the EHR admission process and admission menus. A drug message was added in the EHR to alert prescribers that low-molecular-weight heparin was the preferred agent. Measures were evaluated pre-intervention, year 1 post-intervention, and year 2 post-intervention. Results: After intervention, there were statistically significant increases in the proportion of patients receiving the facility's preferred pharmacologic VTE prophylaxis agent, enoxaparin, and a statistically significant decrease in the proportion of unwarranted VTE prophylaxis. The proportion of inappropriate pharmacologic VTE prophylaxis in high bleeding risk patients decreased, but this result did not reach statistical significance. Conclusion: The improvements observed suggest the beneficial role of CDSTs integrated into the EHR to increase adherence to guideline-based VTE prophylaxis recommendations.
机译：背景：遵循基于指南的静脉血栓栓塞（VTE）预防建议通常是不够的。需要有效的改进策略。目的：根据基于指南的建议，该质量改进计划的目的是增加该机构首选的药理学VTE预防措施的使用，减少不必要的VTE预防措施的使用，并减少高出血风险患者药理学VTE预防措施的使用。方法：临床药剂师率先开发和实施了临床决策支持工具（CDST），该工具集成在退伍军人健康管理局电子健康记录（EHR）中。CDST侧重于急性病患者的VTE预防，并指导处方医生遵循基于指南的建议。审查和批准后，CDST在EHR中激活。随后的干预发生在干预后第2年，将该CDST嵌入EHR入院流程和入院菜单。EHR中增加了药物信息，以提醒处方医生低分子肝素是首选药物。分别在干预前、干预后1年、干预后2年进行评估。结果：干预后，接受该机构首选药理学VTE预防药物依诺肝素的患者比例在统计学上显著增加，而不必要VTE预防的患者比例在统计学上显著降低。在高出血风险患者中，不当药物VTE预防的比例降低，但这一结果没有达到统计学意义。结论：观察到的改善表明，将CDST整合到EHR中有利于提高对基于指南的VTE预防建议的依从性。

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