Venous thromboprophylaxis in general surgery ward admissions: strategies for improvement.
OBJECTIVE
To estimate the adherence to institutional venous thromboprophylaxis clinical practice guidelines (CPGs) in general surgery patients and to assess the effectiveness of a multi-strategy improvement intervention.


METHODS
A prospective before-after study.


METHODS
Two teaching hospitals located in the city of Buenos Aires, Argentina.


METHODS
Prescriptions belonging to patients admitted to the general surgery wards were evaluated.


METHODS
A multi-strategy intervention that included (i) simplification of institutional CPGs for venous thromboprophylaxis using a single drug at a single dose, based on the American College of Chest Physicians recommendations, (ii) distribution of pocket cards with an algorithm for the implementation of new recommendations to both, physicians and nurses, working in the general surgery units, (iii) educational talks, (iv) paper-based reminders and (v) audit and feedback.


METHODS
The adherence of the venous thromboprophylaxis prescription to the institutional recommendations.


RESULTS
The prescriptions of 100 admitted patients before and 90 after the intervention were included in the analysis. The initial rate of adherence was 31%. After the intervention this rate rose to 71.1% (P< 0.001). The major improvement observed was the reduction in omitted prophylaxis in patients at risk of venous thromboembolism from 45 to 13.3% (P< 0.001). In the adjusted model, prescribing compliance with CPGs was five times more likely during the second stage than during the first stage (OR = 5.60, 95% CI = 2.92-10.74).


CONCLUSIONS
Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.
Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Ciudad Autónoma de Buenos Aires, Argentina. marugalante@gmail.com
Mariana
M
Galante
Agustín
A
Languasco
Daniel
D
Gotta
Soledad
S
Bell
Tomás
T
Lancelotti
Viktoria
V
Knaze
Cristián Lopez
CL
Saubidet
Beatriz
B
Grand
Matías
M
Milberg
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001118:Argentina; D018890:Chemoprevention; D002985:Clinical Protocols; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000379:methods*; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D017984:Enoxaparin