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Prescriber knowledge and attitudes regarding non-administration of prescribed pharmacologic venous thromboembolism prophylaxis

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Abstract

Pharmacologic venous thromboembolism (VTE) prophylaxis is important patient safety practice in hospitalized patients. However, a substantial number of ordered doses are not administered. Patient and nursing attitudes and behaviors can influence whether a patient receives a dose. The objective of this single center study was to evaluate prescriber knowledge and attitudes regarding missed doses of pharmacologic VTE prophylaxis. An anonymous, 9-question survey was administered to internal medicine and general surgery resident physicians. The survey captured prescriber opinions on issues related to non-administration of VTE prophylaxis. Thirty-two percent of medicine residents compared with 3 % of surgery residents felt pharmacologic VTE prophylaxis was not necessary in an independently ambulating patient (P < 0.001). Medicine residents were more likely to agree that it is appropriate for nurses to make clinical decisions to determine whether a dose of pharmacologic VTE prophylaxis should be administered to a patient (24 vs. 0 %, P < 0.001). Study findings indicate the need for additional resident physician education. Further investigation is needed to assess these beliefs and ensure patients receive necessary VTE prophylaxis.

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Acknowledgments

Dr. Haut is the primary investigator of the Mentored Clinician Scientist Development Award K08 1K08HS017952-01 from the Agency for Healthcare Research and Quality entitled “Does Screening Variability Make DVT an Unreliable Quality Measure of Trauma Care?” Dr. Haut receives royalties from Lippincott, Williams, & Wilkins for a book he coauthored (“Avoiding Common ICU Errors”). Dr. Haut is a paid consultant and speaker for the “Preventing Avoidable Venous Thromboembolism— Every Patient, Every Time” VHA IMPERATIV® Advantage Performance Improvement Collaborative. Mr. Lau is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant and a contract (AD-1306-03980) from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department.” Dr. Streiff has received research funding from Portola, Daiichi-Sankyo, and Janssen and consulted for Bio2Medical, BristolMyers Squibb, Daiichi-Sankyo, and Janssen HealthCare; and has given expert witness testimony in various medical malpractice cases. Mr. Lau, Drs. Haut, Streiff and Shermock are supported by a contract from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology” (CE-12-11-4489). Ms. Hobson has given expert witness testimony in various medical malpractice cases.

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Correspondence to Kara L. Piechowski.

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Appendix: VTE prophylaxis provider survey

Appendix: VTE prophylaxis provider survey

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Piechowski, K.L., Elder, S., Efird, L.E. et al. Prescriber knowledge and attitudes regarding non-administration of prescribed pharmacologic venous thromboembolism prophylaxis. J Thromb Thrombolysis 42, 463–470 (2016). https://doi.org/10.1007/s11239-016-1378-8

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