Preprinted standardized orders promote venous thromboembolism prophylaxis compared with traditional handwritten orders: an endorsement of standardized evidence-based practice.

The objective was to determine if a standardized process of care--namely, standardized evidence-based medical orders (SEBMOs)--improves physician compliance with venous thromboembolism (VTE) prophylaxis. A total of 61 physicians received information about VTE prophylaxis after introduction of an admission SEBMO. Hospitalists received enhanced presentations about SEBMOs and their value in VTE prevention; specialists did not. Data were analyzed for 2 cohorts of 249 at-risk patients: one cohort was admitted with SEBMOs and the other with handwritten orders. VTE prophylaxis was ordered for 70% (173 of 249) of the SEBMO cohort compared with 22% (55 of 249) of patients whose physicians handwrote orders (relative risk ratio = 2.97; 95% confidence interval = 2.33-3.79; P < .0001). Specialists, who did not receive the enhanced education, were more likely to use handwritten orders and less likely to comply with prophylaxis standards. Standardized orders promote VTE prophylaxis more than handwritten orders. More rigorous education is required to promote compliance with evidence-based standards of medical practice.

Neuraxial anesthesia and low-molecular-weight heparin prophylaxis in major orthopedic surgery in the wake of the latest American Society of Regional Anesthesia guidelines.

In May 2003, the Second American Society of Regional Anesthesia Consensus Conference statement was issued partly in response to continued safety concerns over the use of regional anesthesia--in particular, neuraxial techniques--with low-molecular-weight heparin (LMWH) prophylaxis in major orthopedic surgery. As the 2003 Consensus statement makes clear, regional anesthesia may be used safely with LMWH prophylaxis. The key to optimizing patient safety, however, depends on a careful calibration of the total daily dose and the timing of the first and subsequent doses of the LMWH drug with the timing and management of the regional anesthetic procedure. Because the challenge of successfully providing regional anesthesia in the presence of LMWH thromboprophylaxis is a clinical one, anesthesiologists should do what they can to ensure that every member of the surgical team has an understanding of current literature and practice guidelines such as those recently published by the American Society of Regional Anesthesia.