A prospective, controlled trial of a pharmacy-driven alert system to increase thromboprophylaxis rates in medical inpatients.

Although venous thromboembolism is an important cause of morbidity and mortality within the hospital, a significant proportion of at-risk inpatients do not receive measures known to reduce the risk of deep vein thrombosis and pulmonary embolism. The objective of the present study was to determine whether a pharmacy-driven alert system would, compared to usual care, be associated with a higher rate of adequate venous thromboembolism prevention measures among at-risk inpatients on a general internal medicine service. The study was a prospective, controlled trial set at a university-based teaching hospital. The participants were adults who were admitted (Monday through Friday) to the general internal medicine inpatient service from 19 June to 21 September 2006. Their treatment included a pharmacist assessment of venous thromboembolism risk and a pharmacist-driven alert to the treating physician. The Proportion of at-risk patients receiving adequate thromboprophylaxis within 36 h of admission was recorded. Overall, 140 patients were at sufficient risk for venous thromboembolism to be included. In the usual care group, prophylactic measures were ordered for 49 (61%) of the 80 patients at moderate to high risk. In the pharmacist-alert group, 44 (73%) of the 60 moderate to high venous thromboembolism-risk patients received adequate thromboprophylaxis (P = 0.15). Although we did not observe a statistically significant difference between the groups, our results are consistent with previous reports suggesting that alert systems can increase the proportion of hospitalized patients who receive adequate measures to prevent venous thromboembolism.