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Thromboprophylaxis awareness among hospital Pharmacists.

Introduction

Many types of researches have shown the benefits of pharmacist-induced anticoagulation services to reduce VTE and complications of bleeding while reducing hospital and health care costs [1]. This can be done through an active role in taking responsibility for the management of anticoagulation; pharmacists must ensure that patients at risk receive appropriate medication at the appropriate dose for the appropriate duration, from the first visit to all internal and external follow-up visits [2]. In addition, pharmacists have a vital role in helping the hospital achieving an effective performance measure by assisting in the development and implementation of local VTE instructions, protocols, and guidelines. Moreover, Pharmacists can offer quality improvement initiatives by aiding to create critical protocols and providing a beneficial effective education to other health care professionals as well as patients [3]. The aim of this study was to analyze the pharmacist role and awareness regarding VTE risk factors and prophylaxis.

Method:

This was a cross-sectional study, in which the survey was performed randomly for all pharmacists in each of the involved medical institutions between the period of November 2018 and April 2019. Two medical institutions were involved, namely Prince Sultan Military Medical City (PSMMC) known as Riyadh Armed Forces Hospital, located in Riyadh, which is considered as one of the most advanced medical centers in the Middle East with a capacity of about 1200 beds, accredited by the Joint Commission International; and King Abd Allah University Hospital (KAAUH), which is in the southern area of Princess Noura University (PNU) Campus, a 300-bed teaching hospital serving PNU faculty, students, and community. All pharmacists regardless of their specialization were asked to fill the questionnaire. The questionnaire, that is adapted from [3] and [4], consisting of three parts: Part I: Demographic data, consisting of 5 items. Part II: Evaluation of knowledge and general attitude, consisting of 5 items (yes or no questions). Part III: Evaluation of patients' education attitude, consisting of two items. Content validity, face validity, and criterion validity were done as a pre-test for this questionnaire. The value of Cronbach's alpha is 0.847, indicating that the questionnaire is measuring what it's supposed to measure.

Results:

A total of 250 questionnaires were distributed in both centers, 209 were retrieved with a response rate of 83.6% (172/200). Table 1 describes the results of the demographic characteristics of 209 respondents. Age distribution indicates that 49.52% of respondents were 30-44 years old, 36.19% were of age less than 30 years, and 13.81% were 45-59 years old. Out of 209 respondents, 60% were females and 40% were males. Qualification was the next important demographic measure of participants; 7.62% had a diploma degree and only 6.67% of them had a Ph.D. Majority (52.86%) had a bachelor's degree and 32.38% had Master' degree. Specialization of participants indicated that 38.57% were specialized in general pharmacy, 36.19% were specialized in clinical pharmacy, and 24.76% were Pharm D specialized. Table 1 also shows years of experience for respondents.

Knowledge evaluation and general attitude is the second part of the questionnaire. For all five items, the 'yes' answer obtained the highest percentage (Table 2). 79.90% of respondents think VTE is a problem among hospital patients, and 20.10% think VTE is not a problem among hospital patients. 84.21% of respondents believe that they are aware of the current VTE prevention guidelines/tools available at their hospital. 26.32% said they don't complete the VTE prophylaxis label on their patients' admission notes and 73.68% stated that they complete the VTE prophylaxis label on their patients' admission notes. Two-thirds of the participants have personally seen incorrect usage/prescription of VTE prophylaxis during the last 3 months, and around 70% corrected what they have seen.

Part 3 of the survey consists of an evaluation of the patient's educational practice (Table 3). 9.57% claimed that they educate their patients about VTE at a very low level. 26.32% educate their patients at a high level. Cumulatively, 59.33% educate their patients at very high or high frequencies. Similarly, 64.02% of participants counsel their patients about their prescribed pharmacological VTE prophylaxis, dose, schedule, route of administration, and possible side effects like bleeding and its signs and symptoms in high or very high frequencies.

Chi-square analysis in Table 4 was used to know the association of awareness of the current VTE prevention guidelines/tools available and demographic characteristics of respondents. Awareness and age were significantly associated with their p-value<0.05, but gender awareness showed no dependence with age as its p-value>0.05. Qualification, experience, and specialization of participants had a significant association with the awareness of VTE prevention guidelines with p-value<0.05.

Discussion

More than half of the respondents (60%) were females, indicating a higher female pharmacist percentage. Cumulatively, 85.71% of respondents had age less than 45 years. Most of the respondents were general pharmacists with a bachelor's degree. As the results show, all the knowledge part questions had a high "yes" percentage; all percentages are more than 75% except for the completion of the VTE prophylaxis label on patients' admission notes (73.68%), which considered an acceptable level for VTE awareness. As indicated by Gao & Kause, 2010, a percentage higher than 75% for yes response is acceptable for VTE knowledge awareness [3]. Regarding error corrections, 95% of the pharmacists that have seen incorrect usage/prescription of VTE prophylaxis, correct that error, which is considered a high positive result. For the pharmacist role regarding patients' education about VTE, DVT, and PE, and their risk factors, signs and symptoms, and preventive measures in one hand only 59.33% educate their patients in high/very high level and this percentage is considered low (below 75%), in the other hand, cumulatively, 80.38% educate their patients at average and high/very high level. 64.12% of pharmacists counsel their patients regarding their VTE medication at a high/very high level and 85.65% of pharmacists do VTE medication counseling at an average/high/very high level. But for the results of pharmacist practice to be acceptable, the high/very high level of patients' education and counseling should exceed 75%. A question regarding the awareness of VTE prevention guidelines is chosen to measure the effect of demographic data on the participants' VTE guidelines awareness, age, qualification, experience, and specialization of participants are making a significant association with an awareness of VTE prevention guidelines. Pharmacist attitudes regarding patients' education and counseling, in addition to the completion of the VTE prophylaxis label on patients' admission notes, need to be considered as a weakness that needs educational programs for the pharmacist to increase the level of VTE awareness among the hospital pharmacists. Moreover, the Middle East region people are considered at very high VTE risk as indicated by Alamiri et al. [5], so pharmacists should educate and counsel their patients on a regular basis.

Conclusion: This was a cross-sectional study that assessed VTE awareness between hospital pharmacists. VTE knowledge between pharmacists was acceptable, but patients' educational and counseling practice for pharmacists was weak, and both medical institutions need to enhance the pharmacist awareness regarding the importance of patients' education about VTE risk factors, signs, symptoms, preventive measures, and counseling regarding their VTE medication.

Conflict of interest

None to declare.

Funding

None

Acknowledgment

The authors would like to acknowledge all pharmacists in both medical centers and a special thank for the pharmacist Reem Al--Subaie in PSMMC, for her cooperation and helpful efforts.

References

[1.] Johnson JL, Riley TT. Oral options for VTE prophylaxis after orthopedic surgery. US Pharm. 2012;2:17.

[2.] Dobesh PP, Trujillo TC, Finks SW. Role of the pharmacist in achieving performance measures to improve the prevention and treatment of venous thromboembolism. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2013 Jun;33(6):650-64.

[3.] Gao F, Kause J. Thromboprophylaxis awareness among hospital staff. British Journal of Nursing. 2010 Oct 14;19(18):1175-8.

[4.] Al-Dorzi HM, Cherfan A, Al-Harbi S, Al-Askar A, Al-Azzam S, Hroub A, Olivier J, Al-Hameed F, Al-Moamary M, Abdelaal M, Poff GA. Knowledge of thromboprophylaxis guidelines pre-and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital. Annals of thoracic medicine. 2013 Jul;8(3):165.

[5.] Alamiri MA, Albsoul-Younes AM, Moh'd Said Al-Ajlouni J. Comparison between aspirin 325 mg and enoxaparin 40 mg as extended thromboprophylactic agents following major orthopedic surgery in Jordan University Hospital. Drugs & Therapy Perspectives. 2019 Jan 23;35(1):36-42.

Mariam Ahmad Alameri (1,2) *, Syed Azhar Bin Syed Sulaiman (3,4)

(1) B. Pharmacy, MSc. Clinical Pharmacy, (2) Ph.D. candidate at the Department of Clinical Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia (USM) Penang, Malaysia. (3) Director of the advanced medical and dental institute, Universiti Sains Malaysia. (4) Institut Perubatan dan Pergigian Termaju, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia.

Address for correspondence: Mariam Ahmad Alameri, Ph.D. candidate at the Department of Clinical Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia (USM) Penang, Malaysia. E-mail: m_alamiri15@yahoo.com
Table 1: Frequency Analysis of demographic
characteristics.

      Factor         Number   Percent. (%)

Age
Less than 30 years     76        36.19%
30-44 years           104        49.52%
45-59 years            29        13.81%
Gender
male                   83        40.00%
female                126        60.00%
Qualification
Diploma                16        7.62%
Bachelor              111        52.86%
Master                 68        32.38%
Ph.D.                  14        6.67%
Specialization
General Pharmacy       81        38.57%
Clinical Pharmacy      76        36.19%
Pharm D                52        24.76%
Experience
Less than 5 years      83        39.52%
5-10 years             78        37.14%
11-15 years            25        11.90%
16-20 years            11        5.24%
>20 years              12        5.71%

Ph.D. = Doctor of Philosophy

Table 2: Evaluation of knowledge and general attitude.

Item                                 Options   Number of   Percent
                                               Responses

Do you think venous                    No         42       20.10%
thromboembolism (VTE) is a
problem among hospital                 yes        167      79.90%
patients?

Are you aware of the current           No         33       15.79%
VTE prevention guidelines/tools
available at your hospital?            Yes        176      84.21%

Do you consider that completing        No         55       26.32%
the VTE prophylaxis label on
your patients' admission notes         Yes        154      73.68%
is important?

Have you personally seen               No         51       24.40%
incorrect usage/prescription of
VTE prophylaxis during the last        Yes        158      75.60%
3 months?

If yes, do you take action to try      No         59       28.22%
correcting the above error?
                                       Yes        150      71.77%
VTE =Venous thromboembolism

Table 3: Evaluation of patients' educational practice.

Items                         Options    Number of   Percent
                                         Responses

How much do you educate      very low       20        9.57%
the patients about VTE
(DVT, and PE), risk             Low         21       10.05%
factors, signs and
symptoms, and preventive      Average       44       21.05%
measures?
                               High         69       33.01%

                             very high      55       26.32%

                             very low       16        7.66%

                                Low         14        6.70%

How much do you educate       Average       45       21.53%
the patients about their
prescribed
pharmacological VTE
prophylaxis, dose,
schedule, route of
administration, and
possible side effects like
bleeding and its signs and
symptoms

                               High         59       28.23%

                             very high      75       35.89%

DVT= Deep Vein Thrombosis, VTE =Venous thromboembolism

Table 1: Contingency table of demographic
variables and awareness effect.

                       Are you aware of the current VTE
                          prevention guidelines/tools
                           available at your hospital?

                     Categories       No   Yes   P-value

Age              Less than 30 years   20   56     0.006
                    30-44 years       9    95
                    45-59 years       4    25
Gender                  Male          10   73     0.229
                       Female         23   103
Qualification         Diploma         10    6       0
                      Bachelor        19   92
                       Master         4    64
                       Ph.D.          0    14
Specialization    General pharmacy    27   54       0
                 Clinical Pharmacy    3    73
                      Pharm D         3    49
Experience       Less than 5 years    24   59       0
                     5-10 years       5    73
                    11-15 years       0    25
                    16-20 years       2     9
                        >20           2    10

Ph.D. = Doctor of Philosophy
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Article Details
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Title Annotation:Original Article
Author:Alameri, Mariam Ahmad; Sulaiman, Syed Azhar Bin Syed
Publication:Archives of Pharmacy Practice
Article Type:Report
Geographic Code:9MALA
Date:Oct 1, 2019
Words:1966
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