Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey

Cook, Deborah J.; Duffett, Mark; Lauzier, François; Ye, Chenglin; Dodek, Peter; Paunovic, Bojan; Fowler, Rob; Kho, Michelle E.; Foster, Denise; Stelfox, Henry T.; Sinuff, T; Zytaruk, Nicole; Wood, Gordon; Cox, Michael J.; Kutsiogiannis, Jim; Jacka, Michael J.; Roussos, Marios; Kumar, Hari R.; Guyatt, Gordon

doi:10.1016/j.jcrc.2014.01.017

Cited by 21 publications

(15 citation statements)

References 26 publications

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“…The survey was purposefully designed to be simple and accessible to garner a representative perspective from all provider professions and therefore captured key concepts, but not granular data. Nevertheless, the survey has been successfully used for a similar purpose by others30; was reliable and reported to have good clinical sensibility. Alternative methodologies such as qualitative analyses of semistructured interviews may have allowed for more in depth exploration of barriers and facilitators to adopting LMWH and de-adopting albumin.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study

et al. 2019

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ObjectiveTo compare and contrast illustrative examples of the adoption of high value practices and the de-adoption of low value practices.Design(1) Retrospective, population-based audit of low molecular weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis (high value practice) and albumin for fluid resuscitation (low value practice) and (2) cross-sectional survey of healthcare providers.SettingData were collected from nine adult medical-surgical intensive care units (ICUs) in two large Canadian cities. Patients are managed in these ICUs by a group of multiprofessional and multidisciplinary healthcare providers.ParticipantsParticipants included 6946 ICU admissions and 309 healthcare providers from the same ICUs.Main outcome measures(1) The use of LMWH for VTE prophylaxis (per cent ICU days) and albumin for fluid resuscitation (per cent of patients); and (2) provider knowledge of evidence underpinning these practices, and barriers and facilitators to adopt and de-adopt these practices.ResultsLMWH was administered on 38.7% of ICU days, and 20.0% of patients received albumin.Most participants had knowledge of evidence underpinning VTE prophylaxis and fluid resuscitation (59.1% and 84.2%, respectively). Providers perceived these practices to be followed. The most commonly reported barrier to adoption was insufficient knowledge/understanding (32.8%), and to de-adoption was clinical leader preferences (33.2%). On-site education was the most commonly identified facilitator for adoption and de-adoption (67.8% and 68.6%, respectively).ConclusionsDespite knowledge of and self-reported adherence to best practices, the audit demonstrated opportunity to improve. Provider-reported barriers and facilitators to adoption and de-adoption are broadly similar.

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Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study

et al. 2019

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“…Un factor que desfavorece el uso y manejo adecuado de tromboprofilaxis es el desconocimiento de conceptos sobre el tema [30] . Nuestro estudio identificó que un 15,81% presentaba un IMPROVE Bleeding Score ≥ 7.…”

Section: Discussionunclassified

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

et al. 2018

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Objetivo: Describir las características de la población con patologías no quirúrgicas en quien se indicó manejo de tromboprofilaxis farmacológica en un hospital de tercer nivel y determinar la indicación según riesgo de tromboembolia venosa (VTE) y sangrado con las escalas Padua e IMPROVE Bleeding Score. Materiales y métodos: estudio observacional, descriptivo, de corte transversal que incluyó a pacientes > 18 años, con patología no quirúrgica del servicio de medicina interna, con estancia hospitalaria mínima de 48 horas, atendidos entre el 1 de junio de 2015 a 1 de junio de 2016. En la valoración de riesgo de VTE y sangrado se aplicaron las escalas Padua e IMPROVE Bleeding Score, respectivamente. Resultados: se incluyeron 531 pacientes, de los que el 51,78% fueron hombres, con una edad promedio de 66 años y hospitalización de 37,2 días. La indicación farmacológica más empleada fue la heparina de bajo peso molecular (76,3%). De acuerdo a la escala de Padua, solo 225 pacientes (42,37%) tenían un alto riesgo de tener VTE; según la IMPROVE Bleeding Score, 447 (84,18%) pacientes presentaban bajo riesgo de sangrado y 84 pacientes (15,81%) alto riesgo. Además, se observó que los pacientes con puntaje PADUA ≥ 4, el 21,33% tenía puntaje IMPROVE Bleeding Score ≥7, adicionalmente el 20,23% de los pacientes con alto riesgo de sangrado según esta última escala presentó un episodio de sangrado. Conclusión: se evidenció un sobreuso de tromboprofilaxis farmacológica, lo cual se ve reflejado en episodios de sangrado en paciente que no tenían indicado su uso.

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“…For example, patients might consistently rank symptom management or preservation of sleep as a higher priority for improvement than physicians . Conversely, patients might be unaware of important clinical interventions warranting improvements (eg, venous thromboembolism prophylaxis) …”

Section: Introductionmentioning

confidence: 99%

“…19 Conversely, patients might be unaware of important clinical interventions warranting improvements (eg, venous thromboembolism prophylaxis). 20 To begin to understand how to best reconcile the priorities of diverse groups of health-care stakeholders, we undertook a programme of work to establish priorities for improving the care of critically ill patients admitted to intensive care units (ICU). First, health-care providers (ie, those providers most directly involved in providing patient care in the ICU-physicians, nurses, respiratory therapists and pharmacists) and decision makers (ie, those individuals most directly involved in overseeing patient care in the ICU-unit managers and directors) generated a comprehensive list of candidate daily care practices in the ICU that warrant improvement and subsequently selected nine practices as priorities for quality improvement initiatives.…”

Section: Introductionmentioning

confidence: 99%

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

McKenzie

Potestio

Boyd

et al. 2017

Health Expectations

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BackgroundProviders have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations.ObjectiveTo describe the decision‐making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list.DesignWe employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio‐recorded, transcribed and analysed using qualitative content analysis to explore the decision‐making process for establishing consensus.Setting and participantsNine panellists including three providers, three decision makers and three family members of previously critically ill patients.ResultsPanellists rated and revised 28 priorities over three rounds of review and reached consensus on the “Top 5” priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion.ConclusionsOur study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.

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Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey

Cited by 21 publications

References 26 publications

Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study

Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

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