Improvement of venous thromboembolism prophylaxis by attaching printed thrombosis risk assessment tool and recommendations to patients hospital charts.
Evidence suggests that venous thromboembolism prophylaxis (VTEP) is still significantly underused despite its relationship with morbidity, mortality. Previous studies showed that computerized reminders have resulted in increased rates of VTEP. However, this system is not available in most hospitals especially in developing countries. We hypothesized that attaching written guidelines to patients hospital chart during admission would act as reminder.


METHODS
This pre and post-interventional study included three parts: (i) Baseline survey of VTEP (ii) over the following nine months we attached a printed risk assessment tool and recommendation during admission to first page of patient chart. (iii) We reevaluated VTEP similar to phase one.


RESULTS
This prospective pre-intervention post-intervention study was conducted in 1202 surgical patients evaluated for venous thromboembolism risk and VTEP performance. Any type prophylaxis was 20.0% before and 37.6% after intervention (p value < 0.001). Appropriateness of prophylaxis was 19.1% before and 33.8% after intervention (p value < 0.001). After intervention VTEP rate increased from 8.5% to 19.3% in moderate risk group, from 18.5% to 39.1% in high risk and from 28.1% to 45.1% in highest risk group.


CONCLUSIONS
A simple intervention can improve VTEP rate in settings where electronic alert is not available. VTEP is underused despite improvement. There is still a high gap between evidence and practice.
Faculty of Medicine, Urmia University of Medical Sciences, Urmmia, Iran. mohamadrahimirad@gmail.com
Mohammad Hossein
MH
Rahimni-Rad
Seidsoma
S
SeidSalehi
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007492:Iran; D008297:Male; D008499:Medical Records; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D011446:Prospective Studies; D017010:Reminder Systems; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants