Education, Teaching, and Quality Improvement |

Leading Practice in Venous Thromboembolism Prophylaxis FREE TO VIEW

Eduardo Sad, MD; Maria Chiara Chindamo; Fernando Afonso, MD; Oneide Silva; Kelviane Baêta; Wagner Schiavinni; Jerffeson Dias
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Critical Care, Hospital Barra Dor, Belo Horizonte, Minas Gerais, Brazil

Chest. 2014;146(4_MeetingAbstracts):546A. doi:10.1378/chest.1995138
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SESSION TITLE: Quality & Clinical Improvement II

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM

PURPOSE: The implementation of VTE prevention protocol is considered effective at reducing the risk of events in hospitalized patients. The aims of our study are to present the assistance flow, assessment and monitoring tools, and the efficacy rate of VTE prophylaxis protocols.

METHODS: A protocol for prevention of VTE was developed based on the Safety Zone Program, updated in accordance with the Guidelines of the 9th ACCP. We established a Multidisciplinary Commission to assign the elaboration of the institutional protocol, promote learning actions with medical staff, conduct periodic audits, monitor results, and establish communication strategies and participation of patients and families in measures of thromboprophylaxis. The protocol monitoring is focused on the participation of the clinical pharmacist responsible for assessing risk of VTE within 24-48h of admission, reassessing every 48h and intervening in case of non-compliance. In intensive care units, VTE risk is evaluated through a daily checklist to assess the adequacy of prophylaxis using a Hospital Management Program, EPIMED Monitor. The compliance is also reevaluated by the pharmacist at least every 48h. Medical professionals with low adhesion to the program receive personal orientation from the Committee. The Protocol includes control of correct use of mechanical devices and early ambulation stimulation (use of “Daily walking diary” and rehabilitation program by physiotherapists). All cases of VTE in hospitalized patients and readmissions within 30 days for VTE were analyzed.

RESULTS: We evaluated 5819 patients between Oct 2012 and Sep 2013 and results of performance markers were the following: 1)Mean proportion of patients with risk assessment within the first 24h in ICU: 95%; 2)Mean proportion of clinical patients with indication, use and monitoring of therapy, according to institutional protocol: 94%; 3)Mean proportion of patients with surgery of moderate and high risk who received recommended treatment: 87%; 4)Mean proportion of surgical and clinical patients that appropriately used mechanical methods: 95%; 5) Incidence of DVT: 0.3%; 6)Incidence of PE: 0.05%; 7)Mortality from VTE: 0.03%; and 8) Readmission within 30 days for VTE: 0.02%.

CONCLUSIONS: A systematic risk assessment tool is important to improve knowledge and adhesion to thromboprophylaxis, which associated to regular analysis of VTE cases leads to an improvement in medical care.

CLINICAL IMPLICATIONS: A VTE prophylaxis program effectively reduces events in hospitalized patients.

DISCLOSURE: The following authors have nothing to disclose: Eduardo Sad, Maria Chiara Chindamo, Fernando Afonso, Oneide Silva, Kelviane Baêta, Wagner Schiavinni, Jerffeson Dias

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