The Impact of a Web-based Clinical Decision Support System on Adherence to Venous Thromboembolism Prophylaxis Guidelines in ICU Nonsurgical Patients: A Prospective Study

Abstract

Background There are gaps between expert recommendations and clinical practices in venous thromboembolism (VTE) prophylaxis among nonsurgical patients worldwide. The rate of adherence to evidence-based practice is inadequate in the nonsurgical population. Therefore, this study aimed to evaluate the effect of clinical decision support systems (CDSS) on the appropriate VTE prophylaxis in nonsurgical patients in the intensive care unit (ICU). Methods We conducted a cross-sectional study, pre- and post-implementation CDSS for recommendation VTE prophylaxis order set, to analyze the effect of the CDSS within the Computerized provider order entry system (CPOE) on the appropriate VTE prophylaxis in three ICUs of the Nemazee hospital before intervention from 20 April to 21 November 2020 and post-intervention duration 7 April to 9 July 2021. The pre-intervention and post-intervention phase samples comprised 175 and 27 patients, respectively. P-value < 0.05 was considered a significant level. All statistical analysis was performed by SPSS version 24. Results Adherence to VTE prophylaxis guidelines after introducing CDSS for the recommendation of VTE prophylaxis within the CPOE systems in nonsurgical patients in ICUs increased from 48.6–77.8% (p-value < 01). However, mortality rate of pre-intervention (13.80%) vs post-intervention (14.80%) (p-value = 0.88) and means of length of stay of pre-intervention (13.66) vs post-intervention (13.63) (p-value = 0.49) in ICU were not significantly changed after introduction of CDSS for recommendation of VTE prophylaxis order sets. Conclusion The results indicate that the CDSS for recommendation VTE prophylaxis within CPOE improves adherence to VTE prophylaxis in nonsurgical patients at ICUs, which assists the provider in selecting the most tailored VTE prophylaxis. Further studies are needed to evaluate implemented CDSS for the recommendation of the VTE prophylaxis in nonsurgical patients at the local and national levels.