Het effect van de introductie van een clinical decision support tool op het percentage adequaat voorgeschreven LMWH-tromboseprofylaxe

The effect of the implementation of a clinical decision support (CDS) tool on the percentage of adequately prescribed LMWH-thromboprophylaxis Background Non-surgical patients have an increased risk of developing a venous thromboembolism (VTE) during hospital admission. This risk can be reduced by thrombo-prophylaxis with low molecular weight heparins (LMWHs). In thromboprophylaxis guidelines the Padua Prediction Score (PPS) has been suggested as the best available model to assess the risk of VTE in these patients, but adherence to these guidelines is known to be low. Objective To increase the percentage of adequately prescribed thromboprophylaxis with a LMWH in patients with a high VTE risk by implementation of an intervention consisting of a clinical decision support (CDS) tool in the electronic health record. Secondary specificity and sensitivity of the CDS tool were determined. Design and methods Data on the PPS and thromboprophylaxis in non-surgical patients (> 18 years) were prospectively collected for a total of ten time points before and after the implementation of the intervention. Patients who recently (< 1 week) underwent a percutaneous coronary intervention, and palliative patients were excluded. A time series analysis was performed using an autoregressive integrated moving average (ARIMA) model to examine the effect of the intervention on the percentage of adequately prescribed LMWH thromboprophylaxis. Results 400 patients were included, 200 patients pre- and 200 patients post-intervention. Assuming a direct effect of the intervention on the percentage of adequately prescribed LMWH thromboprophylaxis a level effect of 7.5% was calculated, this level effect was not significant (P = 0.19). The CDS tool had a sensitivity of 92% and a specificity of 68%. Conclusion The implementation of a CDS tool had no significant effect on the percentage of patients adequately treated with thromboprophylaxis in an interrupted time series analysis. The CDS tool was able to successfully identify patients with a high risk of developing a VTE.