Intervention targeted at nurses to improve venous thromboprophylaxis.
OBJECTIVE
To assess the effectiveness of an intervention targeting both physicians and nurses vs. physicians only in improving venous thromboprophylaxis for older patients.


METHODS
Cluster randomized trial.


METHODS
Fifty hospital-based post-acute care departments in France.


METHODS
Patients aged 65 years or older.


METHODS
A multifaceted intervention to implement a clinical practice guideline addressing venous thromboprophylaxis.


METHODS
The effectiveness outcomes were elastic stocking use, ambulation or mobilization under the supervision of a physical therapist and anticoagulant-based prophylaxis. Patient outcomes included deep vein thrombosis and anticoagulant-related adverse events.


RESULTS
One department allocated to the intervention targeted at physicians only and seven departments allocated to the intervention targeted at both physicians and nurses dropped out of the study. Compared with the intervention targeted at physicians only (n = 497 patients), the intervention targeted at both physicians and nurses (n = 315 patients) was associated with a higher rate of mobilization (62 vs. 37%, P < 0.001) and comparable levels of elastic stocking (32 vs. 39%, P = 0.74) and anticoagulant (55 vs. 48%, P = 0.36) use. The rates of deep vein thrombosis (15 vs. 13%, P = 0.50), bleeding (1 vs. 1%, P = 0.99) and thrombocytopaenia (0 vs. 0.2%, P = 0.99) did not differ between the two groups.


CONCLUSIONS
A multifaceted intervention targeting nurses in addition to physicians can increase the frequency of mobilization of older patients to prevent venous thromboembolism but does not alter the use of elastic stockings and anticoagulant. A differential drop-out of departments might have contributed to creating imbalances in baseline characteristics and outcomes in this study.
Labarere
Jose
J
Unité d'Evaluation Médicale, Pavillon Taillefer, Centre Hospitalier Universitaire, BP 217, 38043 Grenoble Cedex 9, France. jLabarere@chu-grenoble.fr
Bosson
Jean-Luc
JL
Sevestre
Marie-Antoinette
MA
Sellier
Elodie
E
Richaud
Cecile
C
Legagneux
Annie
A
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D053828:Stockings, Compression / Q000706:statistics & numerical data; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D016138:Walking / Q000502:physiology / Q000706:statistics & numerical data*
D000925:Anticoagulants