Mandatory Caprini Score Documentation and Incidence of Hospital VTE

ASH Abstract Submission:

Background:

Hospital acquired VTE continues to be a source of morbidity and mortality for patients. The Caprini risk score is a risk assessment tool for the occurrence of venous thromboembolism. Though initially developed for use among surgical patients, it is now being applied to many hospitalized patients. It involves 20 variables and it is derived from a prospective study of general surgery patients published in 1991. After adding Caprini score documentation to internal medicine admission order sets and general surgery pre-procedural order sets, the 90 day incidence of hospital acquired VTE went from 67 to 0. Prior to the change, documentation of Caprini score was poor and ordered VTE prophylaxis did not align with the documented Caprini score, ultimately effecting compliance to prophylaxis and affecting patient safety.

Methods:

In order to decrease the rate of VTE throughout the Orlando Health hospital system, changes were made to the electronic medical record (EMR) to better improve selection of proper VTE prophylaxis. Because VTE prophylaxis was frequently not ordered appropriately, the ability to personalize order sets for VTE was removed 5/3/2022. We implemented a mandatory order set requiring documentation of Caprini score in two admission order sets. Subsequent VTE prophylaxis was ordered depending on the calculated score. The EMR changes were implemented 6/8/2022 as a pilot program within both internal medicine admission order sets and general surgery pre-procedure admission order sets. Incidence of hospital acquired VTE as well as re-admission rates were monitored over the subsequent period.

Results:

In the period immediately prior to implementation of this program, there were 67 hospital acquired DVT/PE events. After the pilot program went live 6/8/22, there were 0 preventable hospital acquired VTE for the subsequent period.

VTE prophylaxis was ordered within 24hrs of admission 81% of the time.

During the whole study phase there were 95 total readmissions due to DVT/PE, 35 from DVT, 29 from PE, and 25 from DVT/PE. Of these, only 3 occurred after implementation of pilot program.

Conclusions:

Addition of Caprini score documentation to internal medicine admission order set and pre-procedural general surgery order set prevented hospital acquired VTE across the hospital system over a 30 day period, and dramatically decreased readmission rate due to VTE/PE. These results have a direct effect on patient safety and quality of patient care.

No relevant conflicts of interest to declare.