Preprinted standardized orders promote venous thromboembolism prophylaxis compared with traditional handwritten orders: an endorsement of standardized evidence-based practice.
The objective was to determine if a standardized process of care--namely, standardized evidence-based medical orders (SEBMOs)--improves physician compliance with venous thromboembolism (VTE) prophylaxis. A total of 61 physicians received information about VTE prophylaxis after introduction of an admission SEBMO. Hospitalists received enhanced presentations about SEBMOs and their value in VTE prevention; specialists did not. Data were analyzed for 2 cohorts of 249 at-risk patients: one cohort was admitted with SEBMOs and the other with handwritten orders. VTE prophylaxis was ordered for 70% (173 of 249) of the SEBMO cohort compared with 22% (55 of 249) of patients whose physicians handwrote orders (relative risk ratio = 2.97; 95% confidence interval = 2.33-3.79; P < .0001). Specialists, who did not receive the enhanced education, were more likely to use handwritten orders and less likely to comply with prophylaxis standards. Standardized orders promote VTE prophylaxis more than handwritten orders. More rigorous education is required to promote compliance with evidence-based standards of medical practice.
Gaylis
Franklin D
FD
University of California San Diego, La Jolla, CA, USA. gaylisf@aol.com
Van
Sothary J
SJ
Daneshvar
Michael A
MA
Gaylis
Gregory M
GM
Gaylis
Jaclyn B
JB
Sheela
Rose B
RB
Stern
Electa J
EJ
Hanson
Peter B
PB
Sur
Roger L
RL
D015331:Cohort Studies; D055317:Evidence-Based Practice; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000706:statistics & numerical data; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*