Improving inpatient venous thromboembolism prophylaxis.
OBJECTIVE
The number and types of inpatients given inadequate prophylaxis for venous thromboembolism (VTE) are not known; patients receive less than appropriate prophylaxis with some frequency.


METHODS
Initially we evaluated VTE prophylaxis at a community hospital by comparing prophylaxis patterns in adult inpatients for whom some prophylaxis was indicated. Patients were categorized as medical, general surgery, and orthopedic, then categorized as "appropriate," "suboptimal," or "none" in terms of VTE prophylaxis. After initial data collection, we performed an intervention on medical patients using a VTE risk assessment tool; a printed evaluation containing the VTE risk assessment score with related VTE prophylaxis regimens was placed in the patients' charts, after which prophylaxis patterns were compared between preintervention and postintervention medical patients.


RESULTS
Initial data collected from 116 medical, 110 general surgery, and 72 orthopedic patients (n = 298) showed that there was a significant association between diagnosis category and level of observed appropriate VTE prophylaxis (P < 0.0001). Fifty-six medical patients (48%) received no prophylaxis, compared to 40 (36%) general surgery patients and 12 (17%) orthopedic patients. In the second phase, 74 medical patients on whom the intervention was performed were compared to 116 preintervention medical patients (n = 190). The findings showed that intervention status had a significant association with level of appropriate VTE prophylaxis (P < 0.0001).


CONCLUSIONS
An increase in appropriate VTE prophylaxis was observed after a system-level intervention.
Shedd
Glenn C
GC
Athens Regional Medical Center, Georgia, USA. gcshedd@mac.com
Franklin
Christine
C
Schumacher
Autumn M
AM
Green
Dale E
DE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D019983:Guideline Adherence; D006493:Heparin / Q000008:administration & dosage; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D007279:Injections, Subcutaneous; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D053828:Stockings, Compression; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin; D006493:Heparin