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Thromboprophylaxis Management in Surgical Patients

The Efficacy of a Protocol in the Electronic Prescription Program

Ribed, Almudena PharmD, PhD, AR; de Lorenzo-Pinto, Ana PharmD, PhD, ALP; Lallana-Sainz, Elena PharmD, ELS; Llorente-Parrado, Cesar CLP; Chana-Rodríguez, Francisco MD, FCR; Sanjurjo-Sáez, Maria PharmD, MSS

doi: 10.1097/QMH.0000000000000227
Quality Management Applications

Background and Objective: Venous thromboembolism (VTE) continues to be a problem in surgical patients, but thromboprophylactic measures are not always implemented. This study aimed to evaluate thromboprophylaxis practice in surgical patients at our institution by assessing appropriateness during admission and discharge; 60-day clinical outcomes are analyzed, and finally further interventions are discussed for continued improvement.

Methods: A cross-sectional, observational study was conducted in patients undergoing orthopedic and abdominal surgical procedures. Initially, the institution protocol was updated and embedded in the Computerized Physician Order Entry system. We then assessed prospective adequacy of thromboprophylaxis as per established in the protocol. The primary endpoint was thromboprophylaxis initiation and, secondarily, the quality of related prescriptions during hospitalization and at discharge.

Results: A total of 114 patients were included in the study. According to VTE risk, thromboprophylaxis was initiated in 85.1% of the patients as needed during hospitalization and 94.8% at discharge. The following inadequacies versus the protocol were found: no duration information in the discharge summary (32.5%), incorrect postsurgical administration time of pharmacological prophylaxis (15.8%), omission of mechanical prophylaxis (13.7%), misdosing (9.6%), and omission of pharmacological prophylaxis (2.6%). No VTE events occurred 60 days postdischarge.

Conclusion: The electronic protocol was an effective tool, as evidenced by the fact that thromboprophylaxis was initiated in the majority of surgical patients in our institution during hospitalization and at discharge. Still, some aspects leave room for improvement (duration, dosing, and timing), and further measures such as implementation of Electronic Medication Administration Records and new functionalities in the Clinical Decision Support systems are proposed.

Pharmacy Department (Drs Ribed, de Lorenzo-Pinto, Lallana-Sainz, and Sanjurjo-Sáez) Department of Quality and Health Prevention (Dr Llorente-Parrado), and Orthopaedic Department (Dr Chana-Rodríguez), Hospital General Universitario Gregorio Marañón, Instituto Investigación Gregorio Marañón, Madrid, Spain.

Correspondence: Almudena Ribed, PharmD, PhD, AR, Pharmacy Department, Hospital General Universitario Gregorio Marañón, C/doctor Esquerdo 46, 28007 Madrid, Spain (

The authors appreciate the collaboration of all members of the Pharmacy Department, particularly E. Duran-García for her knowledge on thromboprophylaxis guidelines and data collection. The authors also thank A. Rodriguez-Huertas, a hematologist, for advising on the clinical significance and practical recommendations for every patient of the study.

Conflicts of Interest: None declared.

© 2019Wolters Kluwer Health | Lippincott Williams & Wilkins