Pulmonary Vascular Disease |

Sustained Increased Venous Thromboprophylaxis in Acute Medical Inpatients Using a Medical Admissions Proforma FREE TO VIEW

Sarah G, MBBCh; Osman El-muataz, MBBCh; Mary Jane Brassill, MBBCh; Niall Colwell, MD; Christina Donnellan, MBBCh; Sam Kingston, MBBCh; Clare O'Leary, MBBCh; Paud O'Regan, MBBCh; Abdul Siddiqui, MBBCh; Isweri Pillay, MBBCh
Author and Funding Information

Department of Medicine, South Tipperary General Hospital, Tipperary, Ireland

Chest. 2015;148(4_MeetingAbstracts):1000A. doi:10.1378/chest.2281015
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SESSION TITLE: Venous Thromboembolism Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: A 3 cycle audit, over 9 years, aimed to improve thromboprophylaxis prescribing rates in a 255 bed acute hospital, by the introduction of a reminder in the medical admission proforma (MAP). The objectives were to determine whether patients received appropriate thromboprophylaxis, according to the American Association of Chest Physicians (AACP) guidelines and to determine both prescribing rates and the sustainability of a suitable intervention, once found.

METHODS: Retrospective benchmarking of the thromboprophylaxis prescribing rate was undertaken in 2006. Three snapshot audits were performed at 3, 6 and 9 years. After the initial benchmarking, a MAP was introduced, which included a thromboprophylaxis reminder. The position of the reminder was changed in 2009. 100 current medical inpatients were audited at each cycle. Age, gender and principal diagnosis was recorded. Each patient was assessed for venous thromboembolism (VTE) risk by a registered medical physician, according to the American Association of Chest Physicians Guidelines (AACP), by reviewing the patient chart. Appropriate use of thromboprophylaxis was recorded using the patient's drug kardex.

RESULTS: Benchmarking demonstrated that AACP guideline compliance was 37.5% in 2006. Mean age at years 3, 6 and 9 was 63.1, 66.7 and 73.8 years respectively. The male to female ratio was 1.3:1. The percentage of patients at risk for VTE in each cycle was 90, 78 and 92% respectively. Appropriate prescribing of thromboprophylaxis occurred in 75, 86.1 and 87% of patients respectively.

CONCLUSIONS: There has been a sustainable increase in appropriate prescribing in accordance with best practice guidelines for VTE prophylaxis by using a MAP. In order to achieve >98% adherence to guidelines, the format of the reminder has been further simplified. In the next phase of auditing, dosing will be assessed in addition to prescribing rates. Similar hospitals may find the MAP to be a useful method of improving VTE thromboprophylaxis rates in their medical inpatients.

CLINICAL IMPLICATIONS: Thromboprophylaxis is one way to avoid preventable inpatient mortality. It can be estimated that a minimum of 2 lives will be saved per year in a hospital with a 4% mortality rate and approximately 7,500 acute medical inpatient discharges per year, if thromboprophylaxis is 100% complied with.

DISCLOSURE: The following authors have nothing to disclose: Sarah G, Osman El-muataz, Mary Jane Brassill, Niall Colwell, Christina Donnellan, Sam Kingston, Clare O'Leary, Paud O'Regan, Abdul Siddiqui, Isweri Pillay

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