title: Improving guideline compliance: assessment of unit-based reminder for monitoring platelet counts post-PCI.
abstract: In assessing our institution's vascular access site bleeding complication rate, we found (anecdotally) that for many patients platelet count was not measured according to recommendations of the manufacturer of the predominantly used glycoprotein (GP) IIb/IIIa agents, in either the catheterization recovery unit (CRU) or the coronary care unit (CCU). We hypothesized that a unit-focused effort to remind cardiologists to order platelet counts after percutaneous coronary interventions GP IIb/IIIa would improve compliance. Findings indicated that a greater number of patients had platelet counts drawn after a reminder effort had been implemented. For both the first and second draws, the CCU had a higher pre-reminder rate than the CRU. Post-reminder, the CCU had no significant changes, whereas the CRU showed significant increases in both the first and second draws. For post GP IIb/IIIa platelet measurement, aggregate analysis (CRU and CCU) showed that, of those patients who had platelet counts drawn pre-reminder, only 18.2% met the first guideline and only 17.1% met the second. Post-reminder results showed no significant changes for the first or second draws. We concluded that the practical application of a standard operating procedure can have a secondary beneficial effect despite not meeting the stringent parameters set in prescribing guidelines.
authors.affiliation: St. Lukes Hospital, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Belletti
authors.forename: Robert B
authors.initials: RB
authors.lastname: Bolash
authors.forename: Stephen
authors.initials: S
authors.lastname: Arcona
authors.forename: James F
authors.initials: JF
authors.lastname: Reed
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D003325:Coronary Care Units / Q000592:standards*; D004496:Education, Continuing; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010414:Pennsylvania; D010976:Platelet Count; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000008:administration & dosage; D011182:Postoperative Care / Q000592:standards*; D011997:Recovery Room / Q000592:standards*; D017010:Reminder Systems; D012189:Retrospective Studies
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex