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Cost-Consciousness Assignment

Cost-Consciousness Assignment. Ollie Ross DSR 2. Adherence to ACP DVT prophylaxis guidelines. Objective: Evaluate adherence to ACP DVT prophylaxis guidelines in a LBVA ward team and determine if excessive prophylaxis is being utilized. ACP Guidelines.

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Cost-Consciousness Assignment

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  1. Cost-Consciousness Assignment Ollie Ross DSR 2

  2. Adherence to ACP DVT prophylaxis guidelines • Objective: Evaluate adherence to ACP DVT prophylaxis guidelines in a LBVA ward team and determine if excessive prophylaxis is being utilized

  3. ACP Guidelines • Venous Thromboembolism Prophylaxis in Hospitalized Patients: A Clinical Practice Guideline From the American College of Physicians. Qaseem, A., Chou, R., et al. Annals of Internal Medicine. 2011;155:625-632

  4. ACP Recommendation 1 • ACP recommends assessment of the risk for thromboembolism and bleeding in medical (including stroke) patients prior to initiation of prophylaxis of venous thromboembolism (Grade: strong recommendation, moderate-quality evidence).

  5. ACP Recommendation 1 • “Many risk assessment tools are available for estimating thromboembolism risk, but the current evidence is insufficient to recommend a validated tool” • Note: ACCP recommends patients at low risk for DVT/PE require NO prophylaxis

  6. Padua Risk Assessment Model • 3 points: Cancer, past VTE, immobility, thrombophilic condition • 2 points: Trauma or surgery in past month • 1 point: Age 70 or older, CHF, AMI, Ischemic CVA, BMI 30 or greater, hormone use, acute infectious or rheumatologic disorder • Score <4 considered Low Risk

  7. ACP Recommendation 2 • ACP recommends pharmacologic prophylaxis with heparin or a related drug for venous thromboembolism in medical (including stroke) patients unless the assessed risk for bleeding outweighs the likely benefits (Grade: strong recommendation, moderate-quality evidence).

  8. ACP Recommendation 3 • ACP recommends against the use of mechanical prophylaxis with graduated compression stockings for prevention of venous thromboembolism (Grade: strong recommendation, moderate-quality evidence).

  9. ACP Recommendation 3 • “In patients at high risk for bleeding events or in whom heparin is contraindicated for other reasons, intermittent pneumatic compression may be a reasonable option, because evidence suggests that it is beneficial in surgical patients” • “However, intermittent pneumatic compression has not been sufficiently evaluated as a stand-alone intervention in medical patients to reliably estimate benefits and harms”

  10. Methods • One LBVA ward team with over 10 patients was chosen at random • EMR was reviewed to determine what DVT prophylaxis were ordered • Patients were seen to determine if SCDs were in place

  11. Results • 11 patients; all Padua score 4 or greater • 6/11 had only heparin SQ ordered • 2/11 had only SCDs ordered (active bleeding/ surgery planned), but SCDs were not in place (bilateral urostomy bags/ patient refusal) • 1/11 had heparin SQ and SCDs ordered but SCDs were not in place • 1/11 had coumadin (A-fib) and SCDs ordered and SCDs were in place • 1/11 had INR >3 (cirrhosis) so no DVT ppx was ordered

  12. Results • 2/11 had both anticoagulation and SCDs ordered, but only 1/11 was actually receiving both

  13. Take Home Point • ACP DVT prophylaxis guidelines do not recommend simultaneous use of both anticoagulation and mechanical compression devices • Simultaneous use of both anticoagulation and SCDs may be superfluous

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