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Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies

BACKGROUND: Recent studies have documented high rates of non-administration of ordered venous thromboembolism (VTE) prophylaxis doses. Intervention strategies that target all patients have been effective, but prohibitively resource-intensive. We aimed to identify efficient intervention strategies ba...

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Autores principales: Shermock, Kenneth M., Lau, Brandyn D., Haut, Elliott R., Hobson, Deborah B., Ganetsky, Valerie S., Kraus, Peggy S., Efird, Leigh E., Lehmann, Christoph U., Pinto, Brian L., Ross, Patricia A., Streiff, Michael B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683023/
https://www.ncbi.nlm.nih.gov/pubmed/23799091
http://dx.doi.org/10.1371/journal.pone.0066311
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author Shermock, Kenneth M.
Lau, Brandyn D.
Haut, Elliott R.
Hobson, Deborah B.
Ganetsky, Valerie S.
Kraus, Peggy S.
Efird, Leigh E.
Lehmann, Christoph U.
Pinto, Brian L.
Ross, Patricia A.
Streiff, Michael B.
author_facet Shermock, Kenneth M.
Lau, Brandyn D.
Haut, Elliott R.
Hobson, Deborah B.
Ganetsky, Valerie S.
Kraus, Peggy S.
Efird, Leigh E.
Lehmann, Christoph U.
Pinto, Brian L.
Ross, Patricia A.
Streiff, Michael B.
author_sort Shermock, Kenneth M.
collection PubMed
description BACKGROUND: Recent studies have documented high rates of non-administration of ordered venous thromboembolism (VTE) prophylaxis doses. Intervention strategies that target all patients have been effective, but prohibitively resource-intensive. We aimed to identify efficient intervention strategies based on patterns of non-administration of ordered VTE prophylaxis. METHODS AND FINDINGS: In this retrospective review of electronic medication administration records, we included adult hospitalized patients who were ordered pharmacologic VTE prophylaxis with unfractionated heparin or enoxaparin over a seven-month period. The primary measure was the proportion of ordered doses of VTE prophylaxis not administered, assessed at the patient, floor, and floor type levels. Differences in non-administration rates between groups were assessed using generalized estimating equations. A total of 103,160 ordered VTE prophylaxis doses during 10,516 patient visits on twenty-nine patient floors were analyzed. Overall, 11.9% of ordered doses were not administered. Approximately 19% of patients missed at least one quarter and 8% of patients missed over one half of ordered doses. There was marked heterogeneity in non-administration rate at the floor level (range: 5–27%). Patients on medicine floors missed a significantly larger proportion (18%) of ordered doses compared to patients on other floor types (8%, Odds Ratio: 2.4, p<0.0001). However, more than half of patients received at least 86% of their ordered doses, even on the lowest performing floor. The 20% of patients who missed at least two ordered doses accounted for 80% of all missed doses. CONCLUSIONS: A substantial proportion of ordered doses of VTE prophylaxis were not administered. The heterogeneity in non-administration rate between patients, floors, and floor types can be used to target interventions. The small proportion of patients that missed multiple ordered doses accounted for a large majority of non-administered doses. This recognition of the Pareto principle provides opportunity to efficiently target a relatively small group of patients for intervention.
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spelling pubmed-36830232013-06-24 Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies Shermock, Kenneth M. Lau, Brandyn D. Haut, Elliott R. Hobson, Deborah B. Ganetsky, Valerie S. Kraus, Peggy S. Efird, Leigh E. Lehmann, Christoph U. Pinto, Brian L. Ross, Patricia A. Streiff, Michael B. PLoS One Research Article BACKGROUND: Recent studies have documented high rates of non-administration of ordered venous thromboembolism (VTE) prophylaxis doses. Intervention strategies that target all patients have been effective, but prohibitively resource-intensive. We aimed to identify efficient intervention strategies based on patterns of non-administration of ordered VTE prophylaxis. METHODS AND FINDINGS: In this retrospective review of electronic medication administration records, we included adult hospitalized patients who were ordered pharmacologic VTE prophylaxis with unfractionated heparin or enoxaparin over a seven-month period. The primary measure was the proportion of ordered doses of VTE prophylaxis not administered, assessed at the patient, floor, and floor type levels. Differences in non-administration rates between groups were assessed using generalized estimating equations. A total of 103,160 ordered VTE prophylaxis doses during 10,516 patient visits on twenty-nine patient floors were analyzed. Overall, 11.9% of ordered doses were not administered. Approximately 19% of patients missed at least one quarter and 8% of patients missed over one half of ordered doses. There was marked heterogeneity in non-administration rate at the floor level (range: 5–27%). Patients on medicine floors missed a significantly larger proportion (18%) of ordered doses compared to patients on other floor types (8%, Odds Ratio: 2.4, p<0.0001). However, more than half of patients received at least 86% of their ordered doses, even on the lowest performing floor. The 20% of patients who missed at least two ordered doses accounted for 80% of all missed doses. CONCLUSIONS: A substantial proportion of ordered doses of VTE prophylaxis were not administered. The heterogeneity in non-administration rate between patients, floors, and floor types can be used to target interventions. The small proportion of patients that missed multiple ordered doses accounted for a large majority of non-administered doses. This recognition of the Pareto principle provides opportunity to efficiently target a relatively small group of patients for intervention. Public Library of Science 2013-06-14 /pmc/articles/PMC3683023/ /pubmed/23799091 http://dx.doi.org/10.1371/journal.pone.0066311 Text en © 2013 Shermock et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Shermock, Kenneth M.
Lau, Brandyn D.
Haut, Elliott R.
Hobson, Deborah B.
Ganetsky, Valerie S.
Kraus, Peggy S.
Efird, Leigh E.
Lehmann, Christoph U.
Pinto, Brian L.
Ross, Patricia A.
Streiff, Michael B.
Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title_full Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title_fullStr Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title_full_unstemmed Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title_short Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis: Implications for Novel Intervention Strategies
title_sort patterns of non-administration of ordered doses of venous thromboembolism prophylaxis: implications for novel intervention strategies
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683023/
https://www.ncbi.nlm.nih.gov/pubmed/23799091
http://dx.doi.org/10.1371/journal.pone.0066311
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