Pharmacist Involvement Helps Boost VTE Prophylaxis in Surgical Patients at High Risk

A strategy characterized by active engagement of a multidisciplinary team at various stages of patient care significantly improved adherence to optimal perioperative venous thromboembolism (VTE) prophylaxis in high-risk surgical patients, according to a study published online in BMJ Open Quality. 

“Some key facets of this strategy included (1) implementation of routine risk stratification on hospital admission, (2) inclusion of perioperative VTE prophylaxis as a mandatory topic in the preoperative surgical checklist, and (3) collaboration with clinical pharmacists to provide ongoing monitoring and support in the postoperative period,” wrote lead author Leopoldo Muniz da Silva, PhD, São Luiz Hospital-ITAIM/Rede D’Or, São Paulo, Brazil, and coauthors. 

The before-and-after intervention study evaluated the effectiveness of a trio of strategies to improve VTE prophylaxis in high-risk surgical patients at a tertiary hospital. Strategy A, which spanned 783 patients, involved a dedicated hospitalist physician who worked to ensure VTE prophylaxis adherence and correct inadequacies during the postoperative period. In Strategy B, which involved 669 patients, a nurse joined the effort. Finally, Strategy C featured a multidisciplinary team involved at multiple care stages and spanned 622 patients.  

Median adherence rates for VTE pharmacological prophylaxis were 43.29% under Strategy A and 50% under Strategy B, compared with 92.31% under Strategy C, the study found.  

Furthermore, inconsistencies regarding VTE prophylaxis medications, dosages, and dosing intervals were significantly reduced after implementation of strategy C—in large part due to the involvement of clinical pharmacists, researchers pointed out. 

“[T]he active engagement of clinical pharmacists allowed for ongoing adjustment of the prophylactic regimen based on daily risk (re-)stratification,” they wrote. “In addition, this strategy also captured and immediately corrected those (rare) patients who left the operating room without a prophylactic regimen in place.”  

Reference:

da Silva LM, Lima HO, Ferrer R, et al. Comparison of strategies for adherence to venous thromboembolism prophylaxis in high-risk surgical patients: a before and after intervention study. BMJ Open Qual. 2021;10(4):e001583. doi:10.1136/bmjoq-2021-001583