Pharmacy Education for Hospital Clinicians on VTE Prophylaxis Changed Performance, Bringing Guideline-Adherent Care To Most Patients

Earlier today, I wrote of interprofessional clinical education regarding team communication during cardiac surgery. Now I continue the theme of nonphysician education by highlighting contributions of pharmacy education to patient care, and one that particularly relates to (post)surgical care. While this month’s Back-to-School campaign (illustrating published educational outcomes) mainly features recent articles, this 2005 study by Dobesh and Stacy in the Journalof Managed Care Pharmacy (free full text available) is a worthy read for its contributions to quality care research from the pharmacy perspective and scope of practice.

Venous thromboembolism (VTE and/or DVT, PE) is a great concern among surgeons and other physicians. In fact, the VTE evidence-basedguideline by the Institute for Clinical Systems Improvement (ICSI; Jobin et al 2012) names 10 stakeholder groups—including physicians and pharmacists—as “intended users.” The current article used the 2004 American College of Chest Physicians (ACCP) recommendations. Effectively preventing VTE can dictate the chances of successful outcomes and reduce patient readmission rates for many conditions. Because of the challenges of selecting the optimal anticoagulant agent and dosage for individual patients, pharmacists can clearly collaborate with physicians in making decisions about VTE prophylaxis. The 2012 guideline considered pharmacological thromboprophylaxis with unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), fondaparinux, warfarin, aspirin, apixaban, dabigatran, and rivaroxaban—enough therapeutic options to suggest the need for consultation between physicians and pharmacists.  

The pharmacy intervention for nurses, pharmacists, and physicians in the community hospital was traditional in instructional format, involving reinforcing in-service and quality-assurance presentations, as well as newsletters. The educational outcomes assessment method was more notable, using retrospective chart reviews with statistically similar patients before and after the educational intervention (15 months of patient charts before, and 6 months after). Patient chart reviews showed statistically significant and clinically meaningful change in VTE prophylaxis performance in practice. Specifically, both “suitable” and “optimal” prophylaxis increased (P = .006 and P < .0001 respectively), with a fourfold increase in the optimally treated percentage of patients associated with pharmacy education of physicians, nurses, and pharmacists.  

These data show that traditional educational initiatives developed by one health care profession for others can be effective in changing performance, especially when guidelines for practice and risk categories are presented in reinforcing text-based and live formats. This intervention brought guideline-adherent care to 93% of patients with risk, up from 49% before the intervention.  

References cited:
Dobesh PP, Stacy ZA. Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm. 2005;11(9):755-62. PMID: 16300419.
Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S. PMID: 15383478.
Jobin S, Kalliainen L, Adebayo L, et al. Venous thromboembolism prophylaxis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012. Available at: http://www.guideline.gov/content.aspx?id=39350. Accessed September 7, 2015. 


PubMed:  http://www.ncbi.nlm.nih.gov/pubmed/16300419
Journal Free Full Text: http://amcp.org/data/jmcp/contemporary_755-762.pdf
MeSH *Major* terms: Health Personnel/education; Heparin, Low-Molecular-Weight/therapeutic use; Inservice Training; Thromboembolism/prevention & control; Venous Thrombosis/prevention & control