Assessment of a Best Practice Alert in Managing Patients on Anticoagulation

Abstract

Estimated 900,000 patients in the United States and nearly 1 million patients worldwide have Venous Thromboembolism (VTE). Untreated VTE can lead to long-term morbidity and mortality with an increased risk of stroke, heart failure, and death. The use of Best Practice Alerts (BPAs) to encourage prophylaxis will reduce the frequency of VTE among high-risk hospitalized patients as well as educating medical clinicians and adhering to guidelines. BPAs are clinical support tools accessible through EHR to alert the clinicians about a particular element of a patient's care, such as improper dosing, platelet counts, high serum creatinine, infections, blood transfusions, or overuse of testing. The usage of BPAs integrated with the EHR can bring attention to clinicians when prescribing anticoagulants to non-indicated patients and better educate physicians. Single-center, retrospective, chart review study assessed eligible adult patients who were prescribed anticoagulants for VTE prophylaxis. Eligible adult patients were 18 years old and older and were at increased risk for venous thromboembolism. The following were determined: the accuracy of the BPAs firing related to VTE prophylaxis and the providers' acceptance of BPA recommendation. A VTE prophylaxis report was processed through EPIC� at Grady Memorial Hospital between July 27, 2019 � August 26, 2019. One hundred patients were identified, and 207 BPAs were fired during this period. Electronic orders were searched for VTE prophylaxis and mechanical prophylactic measures, including sequential compression devices. Patient notes were screened for past/present medical history, accidents, providers, surgeries/procedures, length of stay, or social history. A list of active and discontinued medications was also screened for the presence of prophylactic pharmacologic measures, including UFH/Lovenox, aspirin, DOACs, or Warfarin. One hundred patients identified and 207 BPAs. The number of BPAs was fired per unique patient weekly and by floor unit. The firing of the BPAs related to VTE prophylaxis was 94.5% accuracy for 36 patients. The provider could not prescribe each unique patient with anticoagulation therapy due to having PCI, dementia, or timing when the BPA fired. During the study period, BPA was accurately fired and assessed. The assessment showed that VTE prophylaxis was not needed due to a specific event that the patient may have had. This specific BPA improved the appropriate management of anticoagulation for VTE prophylaxis in patients.