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

Kenneth M Shermock, Brandyn Lau, Elliott Haut, Deborah B. Hobson, Valerie S. Ganetsky, Peggy S. Kraus, Leigh E. Efird, Christoph U. Lehmann, Brian L. Pinto, Patricia A. Ross, Michael B Streiff

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Article numbere66311
JournalPLoS One
Volume8
Issue number6
DOIs
StatePublished - Jun 14 2013

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Venous Thromboembolism
disease control
dosage
Enoxaparin
Medicine
Heparin
heparin
odds ratio
drug therapy
electronics
medicine
Odds Ratio

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Patterns of Non-Administration of Ordered Doses of Venous Thromboembolism Prophylaxis : Implications for Novel Intervention Strategies. / Shermock, Kenneth M; Lau, Brandyn; Haut, Elliott; Hobson, Deborah B.; Ganetsky, Valerie S.; Kraus, Peggy S.; Efird, Leigh E.; Lehmann, Christoph U.; Pinto, Brian L.; Ross, Patricia A.; Streiff, Michael B.

In: PLoS One, Vol. 8, No. 6, e66311, 14.06.2013.

Research output: Contribution to journalArticle

Shermock, Kenneth M ; Lau, Brandyn ; Haut, Elliott ; 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. In: PLoS One. 2013 ; Vol. 8, No. 6.
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