TY - JOUR T1 - Venous thromboembolism prophylaxis: a path toward more appropriate use JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 605 LP - 607 DO - 10.1136/bmjqs-2015-004612 VL - 24 IS - 10 AU - Paul J Grant AU - Scott A Flanders Y1 - 2015/10/01 UR - http://qualitysafety.bmj.com/content/24/10/605.abstract N2 - Hospital-acquired venous thromboembolism (VTE) is a leading cause of preventable death in hospitalised patients and its prevention with pharmacological prophylaxis has been rated a top patient safety practice.1 Furthermore, the rate at which VTE prophylaxis is administered to ‘at-risk’ patients along with the rate of ‘potentially preventable’ VTE events are national performance measures for US hospitals.2 As a result, many hospitals have spent considerable time and effort implementing processes designed to increase rates of VTE prophylaxis. Missed doses due to patient refusal of VTE prophylaxis is a commonly encountered barrier. Strategies to minimise anticoagulant refusal in patients who would otherwise benefit from prophylaxis are needed.Baillie et al3 describe a multifaceted approach designed to increase adherence to pharmacological VTE prophylaxis in hospitalised patients. By standardising the nursing response to patient refusal of heparin injections (which included a strong focus on patient education), assessing successful administration of VTE prophylaxis on a daily basis via a multidisciplinary rounding checklist, and receiving regular feedback on patient refusal rates, the authors were able to demonstrate a reduction in missed doses in over 20 000 patient admissions to medical and oncology units. Much of the improvement was due to reductions in patient refusal. The fact that the reduction in missed doses was not seen in several units serving as the control group further supports the effectiveness of the intervention.As the authors highlight, which aspects of the multifaceted intervention primarily … ER -