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Implementation of a Pharmacologic Prophylaxis Program to Prevent Obstetric Associated Venous Thromboembolism in an Urban Safety Net Hospital
Abstract Number: F-10
Abstract Type: Original Research
In response to a series of venous thromboembolic (VTE) events, and in accordance with mounting medical evidence, we launched a collaborative project to implement a bundle of care for prophylaxis against pregnancy-associated VTE in our urban, safety-net population.
Methods: A multi-disciplinary team developed and implemented a comprehensive VTE prophylaxis care bundle. The bundle included: a risk assessment tool, a pharmacologic order set, extensive staff and patient education, and medical documentation improvements aimed at in-hospital VTE prophylaxis and post-discharge outpatient prophylaxis. The risk assessment tool, order set and staff "cheat sheet" were developed through series of rapid Plan Do Study Act cycles. The "cheat sheet" contains our risk assessment scoring system, pharmacologic prophyaxis drugs and doses and an algorithm for managing regional anesthesia and pharmacologic prophyaxis in the peri partum period. Laminated versions of the "cheat sheet" are widely distributed throughout our Labor and Delivery unit.
Results: We determined that 45% of our patients are high risk for VTE. In the most recent quarter since the launch of the pharmacologic order set, 98% of our high risk patients received inpatient pharmacologic VTE prophylaxis and were given a prescription for post-discharge medication. In the last quarter of measurement, 73% of patients contacted after discharge reported continuing the recommended chemoprophylaxis.
Conclusion: This project demonstrates that an urban safety-net institution can successfully implement a comprehensive bundle for VTE prophylaxis for hospitalized ante- and post-partum patients with a high rate post-discharge continuation in at risk patients. This care bundle was developed and implemented by a multi-disciplinary team using standard quality improvement tools.