title: Medication chart intervention improves inpatient thromboembolism prophylaxis.
abstract: BACKGROUND
  Inpatient VTE prophylaxis is underused. This study evaluated the effectiveness of the low-cost, multifaceted Australian National Inpatient Medication Chart (NIMC) intervention on improving the quality of VTE prophylaxis and reducing disease. The NIMC intervention incorporated (1) a VTE risk stratification and appropriate prophylaxis guidance tool, (2) a prophylaxis contraindication screening instrument, and (3) a prophylaxis prescription prompt.
  
  
  METHODS
  Retrospective analysis of 2,371 consecutive medical and surgical admissions was performed at a regional referral hospital over 1 year both before and after the intervention. Outcomes measured included the frequency of prophylaxis use, timing of prophylaxis initiation, adherence of the prescribed prophylaxis regimen to guidelines, incidence of VTE disease, and prophylaxis-related complications.
  
  
  RESULTS
  Following NIMC intervention, prophylaxis use increased from 52.7% to 66.5% in medical patients and from 77.5% to 89.1% in surgical patients (P < .001). This increase was still evident 12 months postintervention. After intervention, prophylaxis initiated on admission increased from 65.0% to 83.6% in medical patients and from 60.7% to 78.0% in surgical patients (P < .01); adherence rates to recommended guidelines increased from 55.6% to 71.0% in medical patients and from 53.6% to 75.6% in surgical patients (P < .01). More VTE risk factors independently triggered prophylaxis usage postintervention. The improved quality of prophylaxis did not significantly reduce VTE incidence (risk ratio, 0.88; 95% CI, 0.48-1.62). The rate of prophylaxis-related complications remained similar before and after intervention.
  
  
  CONCLUSIONS
  The multifaceted NIMC intervention resulted in a sustained increase in appropriate and timely VTE prophylaxis in medical and surgical inpatients.
authors.affiliation: Department of General Surgery, The Royal Melbourne Hospital, Parkville. Electronic address: dshliu@bigpond.com.
authors.forename: David S H
authors.initials: DSH
authors.lastname: Liu
authors.affiliation: Department of Medicine, The Royal Melbourne Hospital, Parkville.
authors.forename: Margaret M W
authors.initials: MMW
authors.lastname: Lee
authors.affiliation: Intensive Care Unit, The Royal Melbourne Hospital, Parkville.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Intensive Care Unit, The Royal Melbourne Hospital, Parkville.
authors.forename: Christopher
authors.initials: C
authors.lastname: MacIsaac
authors.affiliation: Intensive Care Unit, The Royal Melbourne Hospital, Parkville.
authors.forename: John
authors.initials: J
authors.lastname: Cade
authors.affiliation: Intensive Care Unit, The Royal Melbourne Hospital, Parkville.
authors.forename: Nerina
authors.initials: N
authors.lastname: Harley
authors.affiliation: Medical Administration, Wimmera Health Care Group, Horsham, VIC, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Wolff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D008510:Medication Systems, Hospital / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy
chemical_list: D000925:Anticoagulants