Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism

Kahn, Susan R.; Morrison, David R.; Cohen, Jack; Emed, Jessica; Tagalakis, Vicky; Roussin, André; Geerts, William

doi:10.1002/14651858.cd008201.pub2

Cited by 83 publications

(64 citation statements)

References 94 publications

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“…Numerous interventions have been proposed to improve VTE prophylaxis prescription, such as electronic alert systems, an opt-out thromboprophylaxis policy, performance evaluation and feedback, as well as practitioner education. [13][14][15][16][17] Although electronic prescription alerts and performance reviews are not be feasible in our setting, the inclusion of a risk assessment sheet on the inpatient prescription charts and providing continuous practitioner education are interventions that should be considered for improving VTE prophylaxis prescription. With such a high percentage of patients at risk, an opt-out policy of thromboprophylaxis prescription should also be considered.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

et al. 2019

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Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from lowresource environments such as Eastern Cape Province. Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape. Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 -83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 -60 years (30%), age 61 -74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy. Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

et al. 2019

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“…Para mejorar la adherencia a la aplicación de las GPC se han obtenido resultados favorables con la aplicación de TIC, además del uso de métodos tradicionales (difusión presencial, sesiones educativas) (26) . En un estudio en el que se comparó la enseñanza tradicional (libros, folletos) con el envío de información a través de mensajes de texto, este último resultó tener mayor tasa de aprendizaje entre los médicos residentes de un servicio de ginecoobstetricia (27) .…”

Section: Discussionunclassified

Evaluación de una intervención para el uso de tromboprofilaxis basada en el envío de alertas electrónicas a médicos residentes de primer año de dos hospitales de Lima, Perú

Delgado-Zapata

Ticse

Gamarra

et al. 2016

Rev Peru Med Exp Salud Publica

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Objetivos. Evaluar la aplicación de una intervención basada en el envío de mensajes de texto y correos electrónicos dirigido a médicos residentes de medicina interna para lograr el incremento de la prescripción de tromboprofilaxis acorde a Guías de Práctica Clínica (GPC). Materiales y métodos. Se realizó un estudio tipo cuasiexperimental en los servicios de hospitalización de medicina interna de dos hospitales generales de Lima, Perú, uno seleccionado para aplicar la intervención y el otro como control. La unidad de análisis fue la hoja de prescripción médica. Se consideró que la intervención debería incrementar la prescripción acorde a GPC con respecto a la evaluación inicial y también respecto al hospital control. Resultados. Se evaluaron 394 hojas de prescripción médica, 227 (57,4%) procedentes del servicio intervenido y 167 (42,4%) correspondieron del control. En el servicio intervenido, inicialmente el 64,5% tuvo una prescripción acorde a GPC, para disminuir a 54,4% luego de la intervención; el sobreuso aumentó de 13,6 a 26,8%. Conclusiones. La intervención basada en el envío de mensajes de texto y correos electrónicos no tuvo impacto, observándose una tendencia al sobreuso de tromboprofilaxis posintervención. Palabras clave: tromboprofilaxis; Mensaje de texto; Mensajes electrónicos, Guías de práctica clínica; Tecnología de la información; Educación médica (Fuente: DeCS BIREME). EVALUATION OF AN INTERVENTION FOR THE USE OF THROMBOPROPHYLAXIS BASED ON ELECTRONIC ALERT TRANSMISSION TO FIRST-YEAR MEDICAL RESIDENTS FROM TWO HOSPITALS OF LIMA, PERU ABSTRACTObjectives. To assess the implementation of an intervention based on the sending of text messages and e-mails to internal medicine residents in order to achieve an increase in the prescription of thromboprophylaxis according to Clinical Practice Guidelines (CPG). Materials and methods. A quasi-experimental study was conducted in the inpatient units of internal medicine at two general hospitals in Lima, Peru: one selected to implement the intervention and the other as control. The unit of analysis was the therapeutic order sheet. It was considered that the intervention should increase the order of thromboprophylaxis according to CPG with respect to the initial assessment and also in relation to the control hospital. Results. A total of 394 therapeutic order sheets, 227 (57.4%) from the intervention hospital and 167 (42.4%) from the control, were evaluated. In the intervention hospital, 64.5% initially had an order of thromboprophylaxis according to CPG, which decreased to 54.4% after the intervention; overuse increased from 13.6 to 26.8%. Conclusions. Intervention based on sending text messages and e-mails had no impact, showing a tendency to overuse of thromboprophylaxis post-intervention. INTRODUCCIÓNEl tromboembolismo venoso (TEV) es una condición frecuente en pacientes hospitalizados, siendo sus manifestaciones más comunes la trombosis venosa profunda (TVP) y el tromboembolismo pulmonar (TEP), que se asocia con eventos que aumentan el tiempo de estancia ho...

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“…33 The implementation of system-wide VTE assessment interventions was the subject of a Cochrane meta-analysis, which included 54 studies of quality improvement initiatives. 34 The authors found that there was a statistically significant improvement in prophylaxis administration with the institution of computerized alerts, provider education, and multifaceted interventions. The combination of multifaceted interventions with electronic alerts was most effective.…”

Section: Quality Improvement Initiativesmentioning

confidence: 99%

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Jacobs

Pannucci

2017

Semin Thromb Hemost

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Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

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Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism

Abstract: Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism (Review)

Cited by 83 publications

References 94 publications

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Evaluación de una intervención para el uso de tromboprofilaxis basada en el envío de alertas electrónicas a médicos residentes de primer año de dos hospitales de Lima, Perú

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

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