Clinical pharmacist assisted thromboprophylactic optimization in general surgical patients

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• 作者：A. Chandrakumar^a ; ^{abinchandrakumar@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; K.K. Ajmal^a ; T.N.K. Suriyaprakash^b ; S. Anusree^a
• 关键词：Pharmacists ; Thromboembolism ; Prevention and control ; General surgery ; Anticoagulants
• 刊名：Le Pharmacien Hospitalier et Clinicien
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：51
• 期：2
• 页码：134-140
• 全文大小：478 K

文摘

Practice of prophylaxis against venous thromboembolism (VTE) following surgical procedures has been in the scenario for about half a century. Despite the surging evidence regarding the clinical and economic efficacy, the practice remains underutilized. The study was aimed at optimizing the prophylactic practices for prevention of VTE in the general surgical patients in a tertiary care hospital using a pharmacist assisted multi-strategy intervention.

Methods

The prospective quasi-experimental study was conducted in general surgical department of a tertiary care hospital in Kerala. The initial audit phase was targeted at assessing the prevailing prophylactic practices and its adequacy in relation to American College of Chest Physicians (ACCP) guidelines. This was followed by an educational phase where physicians were provided the feedback and institutional protocol. The third phase involved intervention through patient risk stratification and prophylactic recommendation by pharmacist concomitantly with reaudit.

Result

The overall non-compliance to the therapy decreased from 52% in the control phase to 20% in the intervention phase with P = 0.0009. The partial compliance to therapy reduced from 40% in the control phase to 32% in the intervention phase with P = 0.4047. Total compliance to therapy increased from 8% in the control to 48% in the intervention stage and the difference was found to be significant with P < 0.0001.

Discussion

The study was effective in increasing the overall compliance to the ACCP 9th guidelines by 40% and the average duration by 1.61 days. Clinical pharmacist assisted multi-strategy interventions were effective in enhancing the appropriateness of the prophylaxis as per the ACCP recommendations.