Improved venous thromboembolism prophylaxis by pharmacist-driven interventions in acutely ill medical patients in Belgium.

BACKGROUND: Forty to 50 % of hospitalized patients with an acute medical illness have risk factors for venous thromboembolism (VTE) and it has been shown that VTE prophylaxis reduced the incidence of VTE events in these patients. However, a large multinational survey, the ENDORSE study, showed that only 37 % of medical patients with VTE risk factors actually received VTE prophylaxis. OBJECTIVE: To evaluate the impact over time of pharmacist-driven interventions aiming at increasing the appropriate use of VTE prophylaxis in acutely ill medical hospitalized patients. SETTING: A Belgian urban academic hospital. METHOD: First, during 1 month, medical and nurse reports of all hospitalized medical patients were reviewed to evaluate the proportion of patients who were on prophylaxis according to clinical practice guidelines. Second, interventions were conducted and included unit-specific physician and nurse education, diffusion of educational tools summarizing VTE prophylaxis guidelines, and reminders. Third, the impact of the interventions on the proportion of patients receiving VTE prophylaxis according to clinical practice guidelines was evaluated after 3 months and 1 year. MAIN OUTCOME MEASURE: Proportion of hospitalized medical patients receiving VTE prophylaxis according to clinical practice guidelines. RESULTS: The baseline evaluation showed that 36 % (26/72) of the patients at risk of VTE received VTE prophylaxis according to clinical practice guidelines. Three months and one year after the interventions, 68 % (55/81), and 72 % (58/81) of the patients at risk of VTE received VTE prophylaxis according to clinical practice guidelines. Among patients not at risk of VTE, 15 % (21/141), 8 % (24/290), and 8 % (27/330) respectively at baseline evaluation, 3 months and 1 year after the interventions, received VTE prophylaxis. CONCLUSION: Pharmacist-driven interventions improved the proportion of acutely ill medical patients receiving VTE prophylaxis according to clinical practice guidelines and the benefit of the interventions was maintained after 1 year.