PURPOSE:We aimed to achieve an increase in the venous thromboembolism (VTE) prophylaxis rate at Brookdale University Hospital and Medical center using implementation of the revised ACCP guidelines and educational intervention.
METHODS:At baseline, 396 consecutive medical patient charts were reviewed. Patients getting heparin, low molecular weight heparin or warfarin for treatment of arterial or venous thromboembolism were excluded. After the baseline audit, a mandatory VTE prophylaxis order form based on the above guidelines was implemented. An educational program comprising of lectures, posters and handouts to the medical residents and attending physicians was also implemented. After 6 months of intervention, 461 consecutive medical patient charts were reviewed. The end-points were: (1) percentage of patients getting optimum VTE prophylaxis as per ACCP guidelines; and (2) percentage of patients getting any form of VTE prophylaxis.
RESULTS:At baseline, the distribution of patients in different categories of VTE risk was: low=0%, moderate=12.6%, high=21.5%, very high risk=65.9%. Only 283 (71.5%) patients were getting any form of VTE prophylaxis at baseline. The number of patients at baseline who were getting optimum prophylaxis was 196 (49.5%). Reasons for under-prophylaxis at baseline were: no prophylaxis ordered = 80 (20.2%); no venodynes available though ordered = 33 (8.33%); under-dosing of heparin as 5000 units s/q q12h = 62 (15.66%); under-dosing of heparin as 3500 units s/q q12h = 19 (4.8%); and under-dosing of enoxaparin as 30 mg s/q OD = 6 (1.52%).After 6 months of intervention, the percentage of patients getting any form of VTE prophylaxis increased to 91.9% (p<0.001). The percentage of patients getting optimum VTE prophylaxis increased to 83.3% (p<0.001).
CONCLUSION:Implementation of a compulsory VTE prophylaxis order form (as per ACCP guidelines), and educational intervention was effective in increasing the VTE prophylaxis rate significantly at our medical center.
CLINICAL IMPLICATIONS:Different studies have shown that VTE prophylaxis is underused in medical patients. This study shows that guideline implementation and educational intervention are effective in increasing the VTE prophylaxis rate in these patients.
DISCLOSURE:Bhavneesh Sharma, No Financial Disclosure Information; No Product/Research Disclosure Information