title: Thromboprophylaxis for hospitalized medical patients: a multicenter qualitative study.
abstract: BACKGROUND
  Observational studies have documented that medical patients infrequently receive venous thromboembolism (VTE) prevention.
  
  
  OBJECTIVE
  To understand the barriers to, and facilitators of, optimal thromboprophylaxis.
  
  
  METHODS
  Hospitalized medical patients.
  
  
  METHODS
  We conducted in-depth interviews with 15 nurses, 6 pharmacists, 12 physicians with both clinical and managerial experience, and 3 hospital administrators.
  
  
  METHODS
  One university-affiliated and 2 community hospitals.
  
  
  METHODS
  Interviews were audiotaped and transcribed verbatim. Transcripts were reviewed and interpreted independently in duplicate.
  
  
  METHODS
  Analysis was conducted using grounded theory.
  
  
  RESULTS
  Physicians and pharmacists affirmed that evidence supporting heparin is strong and understood. Clinicians, particularly nurses, reported that mobilization was important, but were uncertain about how much mobilization was enough. Participants believed that depending on individual physicians for VTE prevention is insufficient. The central finding was that multidisciplinary care was also perceived as a barrier to effective VTE prevention because it can lead to unclear accountability by role confusion. Participants believed that a comprehensive, systems approach was necessary. Suggestions included screening and risk-stratifying all patients, preprinted orders at hospital admission that are regularly reevaluated, and audit and feedback programs. Patient or family-mediated reminders, and administrative interventions, such as hiring more physiotherapists and profiling thromboprophylaxis in hospital accreditation, were also endorsed.
  
  
  CONCLUSIONS
  Universal consideration of thromboprophylaxis finds common ground in multidisciplinary care. However, results of this qualitative study challenge the conviction that either individual physician efforts or multidisciplinary care are sufficient for optimal prevention. To ensure exemplary medical thromboprophylaxis, clinicians regarded coordinated, systemwide processes, aimed at patients, providers, and administrators as essential.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada. debcook@mcmaster.ca
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Andrea
authors.initials: A
authors.lastname: Tkaczyk
authors.forename: Kristina
authors.initials: K
authors.lastname: Lutz
authors.forename: Joseph
authors.initials: J
authors.lastname: McMullin
authors.forename: R Brian
authors.initials: RB
authors.lastname: Haynes
authors.forename: James
authors.initials: J
authors.lastname: Douketis
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010564:Personnel, Hospital; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin