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Optimization of Thromboprophylaxis Use in Hospitalized Pediatric Patients Through Implementation of a Venous
Airka Sanchez1, Lauren Campanella1, Kimberly Perez1
1Department of Pharmacy (AS, LC, KP), St. Joseph's Children's Hospital, Tampa, FL.
Insights
Implementing a venous thromboembolism (VTE) risk assessment tool significantly increased thromboprophylaxis prescribing in pediatric patients. Provider education is key to improving correct tool usage and minimizing bleeding risks.
Area of Science:
- Pediatric critical care medicine
- Pharmacology and therapeutics
- Health informatics
Background:
- Venous thromboembolism (VTE) is a major cause of hospital-acquired illness in children.
- Current pharmacological thromboprophylaxis carries risks of bleeding complications.
- A standardized VTE risk assessment tool is needed to guide prescribing and reduce adverse events.
Purpose of the Study:
- To evaluate the impact of implementing a VTE risk assessment tool on thromboprophylaxis prescribing rates in pediatric patients.
- To assess changes in VTE events and bleeding complications post-implementation.
- To determine the accuracy of VTE risk assessment tool utilization by healthcare providers.
Main Methods:
- Retrospective study comparing thromboprophylaxis prescribing before and after VTE risk assessment tool implementation.
- Inclusion criteria focused on pediatric patients, excluding those with specific conditions or VTE at admission.
- Data analysis included prescribing rates, VTE events, bleeding complications, and tool usage accuracy.
Main Results:
- Thromboprophylaxis prescribing increased significantly from 17.12% to 80.6% post-implementation (p < 0.001).
- No VTE events were observed in either the pre- or post-implementation groups.
- Bleeding complications increased slightly from 3.2% to 7.5%; the tool was used correctly in 48% of cases.
Conclusions:
- The VTE risk assessment tool significantly altered thromboprophylaxis prescribing patterns in pediatric patients.
- Provider reeducation and order set modifications are recommended to improve correct tool utilization.
- Further research may be needed to optimize the tool's impact on patient outcomes and safety.
Objective:
Venous thromboembolism (VTE) is a leading cause of hospital-acquired morbidity for pediatric patients. Pharmacological thromboprophylaxis increases the risk of adverse events such as bleeding complications. There exists a need for a universal VTE risk assessment tool to aid in thromboprophylaxis prescribing while minimizing the risk of adverse events. The objective of this study is to investigate if implementation of a VTE risk assessment tool is associated with a change in the rate of thromboprophylaxis prescribing.
Methods:
This retrospective study evaluated the change in thromboprophylaxis prescribing pre and post implementation of a VTE risk assessment tool. Patients were excluded if they were pregnant, diagnosed with VTE ≤48 hours of admission, presented with VTE symptoms, or if they were diagnosed with multisystem inflammatory syndrome in children (MIS-C) or coronavirus disease (COVID-19).
Results:
A total of 186 pediatric patients were included in this study. Thromboprophylaxis was prescribed in 16/93 (17.12%) and 75/93 (80.6%) patients in the pre- and post-implementation group, respectively (95% CI, 0.523-0.745; p < 0.001). No VTE events occurred in either group. Bleeding complications occurred in 3.2% and 7.5% of patients in the pre- and post-implementation groups, respectively. The risk tool was used in 80.6% of patients; providers used the tool correctly in 48% of patients and incorrectly in 52% of patients.
Conclusion:
Implementation of a VTE risk assessment tool was associated with a statistically significant change in the rate of thromboprophylaxis prescribing. Incorrect use may be minimized by providing provider reeducation and making modifications to the order set.
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