Chest
Volume 141, Issue 3, March 2012, Pages 632-641
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Original Research
Pulmonary Vascular Disease
Medication Chart Intervention Improves Inpatient Thromboembolism Prophylaxis

https://doi.org/10.1378/chest.10-3162Get rights and content

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.

Section snippets

Setting

This study was undertaken at the Wimmera Base Hospital, Victoria, Australia. The hospital is a regional referral center for the Wimmera and Southern Mallee regions of Victoria, serving a population of ∼54,000 people with an 80-bed capacity and 12,000 admissions per year.

The Australian NIMC

The NIMC was commissioned by the Australian Council on Safety and Quality in Health Care. Its aim was to standardize inpatient medication prescription in all Australian public hospitals and has been in practice since June 2006.

Patient Population

Overall, 1,478 (806 preintervention, 672 postintervention) medical and 893 (450 preintervention, 443 postintervention) surgical patients were reviewed over the 25-month study period. Preintervention and postintervention cohorts shared similar baseline characteristics (Table 1). The preintervention medical cohort had a larger number of active malignancies (16.3% vs 11.0%, P = .004) and patients with more than one VTE risk factor (39.5% vs 29.5%, P = .001) but a lower number of endocrine and

Discussion

This study demonstrated that the NIMC intervention resulted in a sustained increase in appropriate prophylaxis use initiated in a timely manner and without compromising patient safety. The incidence of VTE was not significantly reduced following NIMC intervention.

VTE prophylaxis was underused in the preintervention cohort, with < 50% of medical and 60% of surgical patients receiving prophylaxis according to Best Practice Guidelines despite > 80% of these patients being at moderate to high risk

Acknowledgments

Author contributions: Dr Liu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Liu: contributed to the concept and design of the study and interpretation of the data, revised the manuscript critically for important intellectual content, and approved the final version of the manuscript.

Dr Lee: contributed to the concept and design of the study and interpretation of the data, revised the manuscript

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    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).

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