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

Kahn, Susan R.; Morrison, David R.; Diendéré, Gisèle; Piche, Alexandre; Filion, Kristian B.; Klil-Drori, Adi J.; Douketis, James D.; Emed, Jessica; Roussin, André; Tagalakis, Vicky; Morris, Martin; Geerts, William

doi:10.1002/14651858.cd008201.pub3

Cited by 55 publications

(82 citation statements)

References 95 publications

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“…Venous thromboembolism, including deep‐vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of mortality in hospitalized patients (Lederle, Zylla, MacDonald, & Wilt, 2011). Current guidelines recommend pharmacologic thromboprophylaxis in medical inpatients to reduce the risk for venous thromboembolism (Kahn et al, 2012; Qaseem et al, 2011) However, DVT develops in 5% to 20% of hospitalized patients despite pharmacologic thromboprophylaxis (Kahn et al, 2012, 2018; Lederle et al, 2011; Leizorovicz, Haugh, Chapuis, Samama, & Boissel, 1992; Qaseem et al, 2011; Zee et al, 2017) Further, some patients have a contraindication to pharmacologic prophylaxis. For example, continuing anticoagulation can increase the risk for bleeding associated with invasive procedures.…”

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confidence: 99%

Adjunctive Intermittent Pneumatic Compression in Hospitalized Patients Receiving Pharmacologic Prophylaxis for Venous Thromboprophylaxis: A Systematic Review and Meta‐Analysis

Fan

Fang

et al. 2020

J of Nursing Scholarship

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Objectives This study assessed the effect of adjunctive intermittent pneumatic compression (IPC) on venous thromboembolism incidence in hospitalized patients receiving pharmacologic thromboprophylaxis. Methods We searched Medline, Embase, and the Cochrane Central Register with no language restrictions from inception until May 15, 2019, for randomized clinical trials comparing adjunctive IPC in pharmacologic thromboprophylaxis and pharmacologic thromboprophylaxis for venous thromboembolism. Two researchers extracted data from published reports independently. A meta‐analysis was conducted to calculate the risk ratio (RR) using random‐effects models. Primary outcomes were deep venous thrombosis (DVT) and pulmonary embolism (PE). Results Eight trials with a total of 7,354 participants were eligible for analysis. Addition of IPC to pharmacologic prophylaxis compared to pharmacologic prophylaxis alone reduced the risk of DVT by 43% (RR 0.57, 95% confidence interval [CI] 0.35–0.93; I2 = 0%), with benefit only seen in surgical patients (RR 0.30, 95% CI 0.15–0.59; I2 = 0%) and not in medical patients (RR 0.80, 95% CI 0.60–1.07; I2 = 0%; p for interaction = .008). Addition of IPC reduced the risk for PE by 54% (RR 0.46, 95% CI 0.30–0.72; I2 = 0%), with benefit only seen in surgical patients (RR 0.40, 95% CI 0.24–0.65; I2 = 0%) and not in medical patients (RR 0.82, 95% CI 0.32–2.26; I2 = 0%; p for interaction = .18) Conclusions Addition of IPC to pharmacologic prophylaxis confers moderate benefit on venous thromboembolism, with benefit confined to surgical patients. For medical patients, there was a trend toward reduced DVT with adjunctive IPC, which warrants further investigation. Clinical Relevance Venous thromboembolism is not unusual among hospitalized patients despite pharmacologic thromboprophylaxis. Nursing personnel should use adjunctive IPC in surgical patients receiving pharmacologic thromboprophylaxis to prevent venous thromboembolism.

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confidence: 99%

Adjunctive Intermittent Pneumatic Compression in Hospitalized Patients Receiving Pharmacologic Prophylaxis for Venous Thromboprophylaxis: A Systematic Review and Meta‐Analysis

Fan

Fang

et al. 2020

J of Nursing Scholarship

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“…Hospital-acquired VTE is a common complication and a leading cause of mortality and morbidity in hospitalized surgical patients. Those occurring during hospitalization or within the three months after hospitalization have been shown to underlie more than 50% of all cases of the population burden of VTE [417]. Similarly, PE is a serious postoperative complication that represents a source of preventable morbidity and mortality; in the United States it is responsible for 5-10% of all hospital inpatient deaths [418].…”

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confidence: 99%

Medical textiles

Morris

Murray

2020

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“…12 13 Various interventions have been introduced to encourage appropriate VTE assessment and prophylaxis use. 14 In our institution, a full guidance to VTE risk assessment and prophylaxis was available on the intranet and advertised through strategically placed posters. The rate of VTE prophylaxis implementation, however, varied considerably.…”

Section: Introductionmentioning

confidence: 99%

Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow

et al. 2020

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Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. We aimed to improve the rate of VTE prophylaxis use by introducing a paper-based risk assessment tool, with actionable management recommendations within the prescription chart. The rationale was that an assessment tool at the point of prescribing can reduce steps between decision-making and prescribing process, thus promoting confidence and acting as a reminder. A total of 552 prescription charts completed over a period of 29 weeks were examined during the baseline period. In the postintervention period, 871 charts completed over 40 weeks period were examined. The risk assessment tool was completed in 51% of the cases examined in the postintervention period. The introduction of the risk assessment tool was associated with a significant change in the pattern of VTE pharmacological prophylaxis use. The change occurred when the form was made highly visible and enclosed in the prescription chart. The pharmacological prophylaxis use was higher with a completed assessment form than without (mean (SD) 97.5% (7.6%) vs 70.1% (19.4%); p<0.0001). The rate of appropriate prophylaxis decision was 98.2% (SD 5.2%) with a completed assessment form, and 80.7% (SD 17.9%) when it was not used. The qualitative interviews revealed positive themes; many users found it useful, easy and convenient to use. Our data have shown that a paper-based VTE risk assessment tool placed within the prescription chart could substantially improve the rate of appropriate assessment and VTE prophylaxis implementation. This suggests that tool clearly needs to be a seamless integration into the workflow to capture users’ attention and mitigate the influence of time perception.

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

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

Cited by 55 publications

References 95 publications

Adjunctive Intermittent Pneumatic Compression in Hospitalized Patients Receiving Pharmacologic Prophylaxis for Venous Thromboprophylaxis: A Systematic Review and Meta‐Analysis

Adjunctive Intermittent Pneumatic Compression in Hospitalized Patients Receiving Pharmacologic Prophylaxis for Venous Thromboprophylaxis: A Systematic Review and Meta‐Analysis

Medical textiles

Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow

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