Skip to main content

Mandatory Use of CPOE Prevents Blood Clots

 |  By cclark@healthleadersmedia.com  
   October 16, 2012

An effort to force Johns Hopkins doctors to order appropriate treatment to prevent venous thromboembolism or blood clots in their trauma patients has paid off, with more patients getting appropriate medications and fewer patients developing potentially lethal clots.

That's according to a report in the Archives of Surgery by Elliott Haut, MD, associate professor of surgery at Johns Hopkins School of Medicine and colleagues, including Peter Pronovost, MD.

A VTE-programmed computerized physician order entry (CPOE) system "allowed the use of appropriate prophylaxis in patients who did not have a contraindication to these medications to jump up significantly" over the three-year study period, Haut says. Additionally, fewer patients actually developed pulmonary emboli, in which a blood clot found its way to a patient's lung.

The researchers found that after the CPOE system was implemented, there was a 36% relative risk reduction in VTE events and an 83% relative risk reduction in preventable harm, defined as VTE events occurring in patients not ordered appropriate prophylaxis."

Translating the findings to the larger hospital population of cancer patients and medical-surgery patients yields even greater success, he says.

"The important thing was that we made it so that it was mandatory for the person filling in the orders for admissions to go through our order set, an integral part of the routine admission process that couldn't be skipped," Haut explains.

"It wasn't like a piece of paper that someone had to go find and fill it out, if they remembered to do it.

"This was built into the system so that if you tried to skip over it, you couldn't do anything else with the patient—order blood work, any radiology or medications—without doing this order set. We made it mandatory."

Deep vein thrombosis and pulmonary emboli are among the most common causes of death and morbidity in hospitalized patients. The risk is 10 times more common in trauma patients, exacerbated by the injuries the patient arrives with or diseases they may already have.

About 600,000 such events occur each year in the United States, and the Johns Hopkins researchers estimate that one in six die from it.  An estimated 100,000 to 200,000 of them are said to be healthcare-associated. Yet experts say that no more than half of patients who should receive some form of prevention strategy, whether medication or mechanical compressions on their legs, do.

That's because clinicians forget, don't appropriately see their patients as high risk, or because they worry that certain medications may cause some of their patients to bleed.

Haut says that prior to the creation of the hospital-wide computerized physician order entry system, prophylaxis rates hovered around 40% to 60%, but afterwards, rates of preventive care increased to 85% for 1,599 trauma patients included in the study.

The order set also revealed that low molecular-weight heparin rather than unfractionated heparin was the preferred drug for most patients who did not have a risk of bleeding as a contraindication.

The authors say that in factoring cost, the biggest expense is in implementation of an electronic health record system. But after that, "specific VTE prophylaxis algorithms for different patient populations would result in a relatively small incremental cost." The study looked at adult trauma patients treated between January, 2007 and December, 2010.

They concluded that "although many types of interventions have attempted to increase the use of prophylaxis, our proactive, mandatory approach has been shown to be one of the most effective.  More passive strategies, such as laminated cards or educational efforts...were found to be relatively ineffective in increasing prophylaxis compliance rates."

Tagged Under:


Get the latest on healthcare leadership in your inbox.