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Successful Development and Implementation of Pharmacist-led VTE Stewardship. An Australian Tertiary Hospital Perspective

1Concord Repatriation General Hospital, Pharmacy Department, Sydney, Australia, 2University of Tasmania, College of Medicine, Faculty of Health, Hobart, Australia, 3Royal Prince Alfred Hospital, Pharmacy Department, Sydney, Australia, 4Royal Prince Alfred Hospital, Department of Haematology, Sydney, Australia, 5Sydney Local Health District, Executive Unit, Sydney, Australia, 6Concord Repatriation General Hospital, Department of Haematology, Sydney, Australia

Abstract Number: PB1227

Meeting: ISTH 2020 Congress

Theme: Nurses » Nurses and Allied Health

Background: Venous thromboembolism (VTE) is a leading cause of preventable death in hospital. Pharmacist-led interventions can improve prescribing of VTE prophylaxis, however the effectiveness of a dedicated VTE stewardship pharmacist to provide hospital-wide oversight has not been explored.

Aims: To determine if a VTE stewardship pharmacist for a 750-bed Australian tertiary hospital can increase:
(1) the prevalence of appropriate VTE prophylaxis prescription,
(2) VTE risk assessment using an electronic clinical decision support (eCDS) tool,
(3) any form of documented risk assessment and
(4) risk assessment within 24 hours of admission. Single-site data will form part of a planned multi-site study of four network hospitals.

Methods: Barriers to eCDS tool were identified. Stewardship interventions were implemented in two stages:
(1) multi-disciplinary education, daily medication chart auditing and weekly clinician performance feedback within 3 months, and
(2) health promotion and performance feedback gamification within 6 months. A cross-sectional audit of random electronic patient medical records (n=150) was conducted at baseline, 3 and 6 months.

Results: Single site analysis found improvement in VTE risk assessment using the eCDS tool at baseline, 3 and 6 months (21%, 50% and 87%, respectively, p< 0.05) and any documented risk assessment (75%, 78% and 96%, respectively, p< 0.05). There was no improvement in prevalence of risk assessments made within 24 hours of admission. There was no difference in the prescription of appropriate prophylaxis (79%, 83% and 83%, respectively, p=0.63). However, pooled results indicate using the eCDS tool was associated with appropriate VTE prophylaxis prescription (appropriate prophylaxis with eCDS 87%, without eCDS 76% p=0.004). Multi-site analysis is currently in progress.

Conclusions: VTE stewardship pharmacists are a useful addition to the Australian hospital setting and can increase VTE risk assessment, particularly through encouraging use of eCDS tools. Planned multi-site analysis could highlight the full impact of VTE stewardship on prescribing.

To cite this abstract in AMA style:

Chong J, Curtain C, Gad F, Passam F, Soo G, Levy R, Burke R, Dunkley S, Wong-Doo N, Chen V. Successful Development and Implementation of Pharmacist-led VTE Stewardship. An Australian Tertiary Hospital Perspective [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/successful-development-and-implementation-of-pharmacist-led-vte-stewardship-an-australian-tertiary-hospital-perspective/. Accessed September 22, 2023.

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