Chest
Original ResearchPulmonary Vascular DiseaseMedication Chart Intervention Improves Inpatient Thromboembolism Prophylaxis
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
References (33)
- et al.
Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)
Chest
(2008) - et al.
Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study
Lancet
(2008) - et al.
Strategies to improve compliance with evidence-based clinical management guidelines
J Am Coll Surg
(1999) Prevention of venous thromboembolism: a key patient safety priority
J Thromb Haemost
(2009)- et al.
Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest
(2004) - et al.
Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism
Chest
(2007) - et al.
Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada
Thromb Res
(2007) - et al.
The effect of a computerized reminder system on the prevention of postoperative venous thromboembolism
Chest
(2004) - et al.
Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery
Chest
(2003) - et al.
Differences between low-molecular-weight and unfractionated heparin for venous thromboembolism prevention following ischemic stroke: a metaanalysis
Chest
(2008)
Fatal pulmonary embolism in hospitalised medical patients
J Clin Pathol
Prevention of Venous Thromboembolism: Best Practice Guidelines for Australia and New Zealand
Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence
Int Angiol
Implementation and evaluation of guidelines for use of enoxaparin as deep vein thrombosis prophylaxis after major trauma
Pharmacotherapy
Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism
Arch Intern Med
A clinical decision support system for prevention of venous thromboembolism: effect on physician behavior
JAMA
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Comprehensive VTE prevention program incorporating mandatory risk assessment reduces the incidence of hospital-associated thrombosis
2013, ChestCitation Excerpt :Despite this “high” baseline use of thromboprophylaxis, mandating VTE risk assessment with a standardized tool led to improved VTE prevention practice with a consequent significant reduction in HAT. Similar to previous reports, a multifaceted approach to implementation of VTE risk assessment was required.10–12,20 Sustained adherence to VTE risk assessment was facilitated by the development of a prompted electronic tool which was built into routine workflow.
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).