A clinical decision support tool for improving venous thromboembolism risk assessment and thromboprophylaxis prescribing compliance within an electronic medication management system: a retrospective observational study.

Abstract

Background: 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.

Aim: 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.

Method: 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.

Results: 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).

Conclusion: Local implementation of CDS featuring CPOE within the eMMS improved rates of VTE risk assessment documentation and guideline-compliant VTE prophylaxis prescribing.