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Original Research: PULMONARY VASCULAR DISEASE |

Medication Chart Intervention Improves Inpatient Thromboembolism ProphylaxisChart Intervention Improves Thromboprophylaxis

David S. H. Liu, MBBS (Hons), BMedSc; Margaret M. W. Lee, MBBS, BMedSc; Tim Spelman, MBBS; Christopher MacIsaac, MBBS (Hons), PhD; John Cade, MD, PhD, FCCP; Nerina Harley, MBBS, PhD; Alan Wolff, MD
Author and Funding Information

From the Department of General Surgery (Dr Liu), Department of Medicine (Dr Lee), and Intensive Care Unit (Drs Spelman, MacIsaac, Cade, and Harley), The Royal Melbourne Hospital, Parkville; and Medical Administration (Dr Wolff), Wimmera Health Care Group, Horsham, VIC, Australia.

Correspondence to: David S. H. Liu, MBBS (Hons), BMedSc, Department of General Surgery, The Royal Melbourne Hospital, Level 2, Grattan St, Parkville 3050, VIC, Australia; e-mail: dshliu@bigpond.com


For editorial comment see page 578

Funding/Support: This study was supported by The Royal Melbourne Hospital, Intensive Care Unit Education and Research Grant.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):632-641. doi:10.1378/chest.10-3162
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Background:  Inpatient VTE prophylaxis is underused. This study evaluated the effectiveness of the low-cost, multifaceted Australian National Inpatient Medication Chart (NIMC) intervention on improving the quality of VTE prophylaxis and reducing disease. The NIMC intervention incorporated (1) a VTE risk stratification and appropriate prophylaxis guidance tool, (2) a prophylaxis contraindication screening instrument, and (3) a prophylaxis prescription prompt.

Methods:  Retrospective analysis of 2,371 consecutive medical and surgical admissions was performed at a regional referral hospital over 1 year both before and after the intervention. Outcomes measured included the frequency of prophylaxis use, timing of prophylaxis initiation, adherence of the prescribed prophylaxis regimen to guidelines, incidence of VTE disease, and prophylaxis-related complications.

Results:  Following NIMC intervention, prophylaxis use increased from 52.7% to 66.5% in medical patients and from 77.5% to 89.1% in surgical patients (P < .001). This increase was still evident 12 months postintervention. After intervention, prophylaxis initiated on admission increased from 65.0% to 83.6% in medical patients and from 60.7% to 78.0% in surgical patients (P < .01); adherence rates to recommended guidelines increased from 55.6% to 71.0% in medical patients and from 53.6% to 75.6% in surgical patients (P < .01). More VTE risk factors independently triggered prophylaxis usage postintervention. The improved quality of prophylaxis did not significantly reduce VTE incidence (risk ratio, 0.88; 95% CI, 0.48-1.62). The rate of prophylaxis-related complications remained similar before and after intervention.

Conclusions:  The multifaceted NIMC intervention resulted in a sustained increase in appropriate and timely VTE prophylaxis in medical and surgical inpatients.

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