Prevention of venous thromboembolism and safe use of heparin in Spanish hospitals.
OBJECTIVE
To assess compliance with basic and actionable indicators in relation to prevention of venous thromboembolism (VTE) and safe use of heparin.


METHODS
We built, pilot tested and measured a set of evidence-based structure (existence of guidelines) and process (risk assessment for VTE, and dose adjustment to patient weight and renal function when prescribing heparin) indicators in a nation-wide random sample of 22 hospitals. Compliance with process indicators is estimated at national level and by groups of hospitals (stratified by size). At hospital level, compliance is assessed with Lot Quality Acceptance Sampling, for 85% compliance standard (α ≤ 0.05), 55% threshold (β ≤ 0.10). Contents of existing guidelines are analyzed, and their influence on performance is assessed using logistic regression.


METHODS
Acute care hospitals in Spain.


METHODS
None


METHODS
Problem identification through indicators assessment.


RESULTS
Less than half of hospitals have guidelines and their contents are very variable and incomplete. No hospital complies with the standard for VTE prevention and only one for heparin dose adjustment. Nationally, VTE risk assessment is performed in 5.8% of patients (95% CI: 5.6-6.0), and heparin dose is explicitly adjusted in 17.5% (95% CI: 16.8-18.2). Performance is relatively higher in large hospitals and it is associated with the existence of guidelines for VTE prevention (OR: 8.3; 95% CI: 2.1-32.1).


CONCLUSIONS
We have identified some actionable contributing factors to safety problems using evidence-based structure and process indicators. Explicit process design and key clinical interventions (risk assessment for VTE and heparin dose adjustment) should be addressed to improve the current situation.
Preventive Medicine and Public Health, University of Murcia, Murcia, Spain. psaturno@um.es
Pedro J
PJ
Saturno
Zenewton A S
ZA
Gama
Yadira A
YA
Fonseca
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D055317:Evidence-Based Practice; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006761:Hospitals / Q000592:standards; D006801:Humans; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D017751:Safety Management / Q000379:methods / Q000592:standards; D013030:Spain; D059039:Standard of Care; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin