Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacists' intervention study.

ABSTRACT

OBJECTIVE: Venous thromboembolism is a major cause of mortality and morbidity in hospitalized patients. To evaluate physicians' approach to patients' thrombosis risk assessment and practice of thromboembolism prophylaxis in a teaching hospital, we designed an interventional prospective study. SETTING: This pre and post interventional study was conducted in the infectious diseases ward of Imam Khomeini referral hospital, Tehran, Iran. METHOD: Patients' risk factors for thromboembolism during hospitalization course and physicians' thromboembolism prophylaxis approaches were evaluated in a pre and post clinical pharmacists' interventional study. MAIN OUTCOME MEASURE: An internal guideline for prescribing anticoagulants as deep vein thrombosis (DVT) prophylaxis was prepared by clinical pharmacists and the appropriateness of anticoagulants' prescription was evaluated and compared before and after the implementation of consensual guideline. RESULTS: In the pre-intervention phase 69.9% of patients had appropriate indication and received thromboembolism prophylaxis and in 31.1% of enrolled patients anticoagulants were prescribed inappropriately. Prescription of anticoagulants was appropriate in 88.4% of patients during the post interventional phase of the study while 11.6% of admitted patients received prophylaxis improperly. A decrease in the number of patients who had the criterion for DVT prophylaxis but anticoagulants were not administered after the implementation of internal guideline was statistically significant (P=0.001). CONCLUSION: The implementation of clinical pharmacists' prepared protocol helped to a great extent in the improvement of administrating DVT prophylaxis appropriately in patients.