Computerized order entry sets and intensive education improve the rate of prophylaxis for deep vein thrombophlebitis

Purpose: Prophylactic measures to prevent deep vein thrombophlebitis (DVT) have been shown to be successful. Recent studies have shown, however, that they are underutilized; only 35-55% of eligible patients actually receive prophylaxis. We prospectively studied the effectiveness of intensive education and the use of computerized order entry sets in improving the use of DVT prophylaxis in critically ill patients. Methods: All patients admitted to the intensive care units between July 1, 1997 and April 30, 1998 were evaluated. Patients requiring full anticoagulation were excluded. Unit A was the control unit; the staff were not intensively educated nor were computerized order sets available. In Unit B, the staff were intensively educated regarding the risks and benefits of DVT prophylaxis and in Unit C, the staff were both educated and required to use standardized computer entry sets which included DVT prophylaxis. Patients who were having acute bleeding or who were severely thrombocytopenic (platelet count < 50,000) were not supposed to receive heparin. Patients were randomly admitted to the three Units. Results: A total of 2,436 patients were admitted during this period; 609 required full anticoagulation and were excluded. 1,827 patients were evaluated; the mean age was 76.4 (±10.5) and was similar for all three Units. 645 patients were admitted to Unit A (control); 245 (38%) were appropriately prophylaxed; 390 (60.5%) did not receive prophylaxis and 10 (1.6%) were inappropriately prophylaxed. In Unit B, 584 patients were admitted; 362 (62%) received appropriate prophylaxis, 213 (36.5%) did not receive prophylaxis and 9 (1.5%) were inappropriately prophylaxed. In Unit C, 598 patients were admitted; 58 (97.2%) were appropriately given prophylaxis, 7 (1.2%) did not receive prophylaxis and 10 (1.7%) were inappropriately prophylaxed. The rate of appropriate prophylaxis was significantly improved by education alone (62% vs 38.1% {P = 0.01) and even more by the use of computerized order sets (97.2% vs 38% {P = 0.0001} and 97.2% vs 62% {P = 0.01}). The rate of inappropriate use of heparin was the same in all three groups. Conclusions: The combination of intensive education plus the mandatory use of computerized order sets results in almost universal DVT prophylaxis. Clinical Implications: The use of computerized order sets may improve therapy in conditions with accepted therapeutic protocols.