title: Bridging efforts to longitudinally improve and evaluate VEnous thromboembolism prophylaxis uptake in hospitalized cancer patients through Interprofessional Teamwork (BELIEVE IT): a study by Princess Margaret Cancer Centre.
abstract: BACKGROUND
  Despite demonstrable risk of venous thromboembolism (VTE), thromboprophylaxis continues to be underutilized in hospitalized cancer patients. Our study evaluated institutional VTE prophylaxis rates after devising a series of strategic interventions to longitudinally improve adherence rates over a period of eight years.
  
  
  METHODS
  Between 2004 and 2012, a series of interventions were implemented to improve the thromboprophylaxis rate among patients with solid tumours hospitalized at our institution using quality improvement methodology. Interventions included development of guidelines and institutional policies coupled with educational in-services for physicians, nurses and pharmacists and engagement of the Cancer Quality Committee. Thromboprophylaxis rates were monitored to assess response to interventions.
  
  
  RESULTS
  At the outset in 2004, 11 of 57 (19.3%) eligible patients received appropriate pharmacological prophylaxis and formed the baseline of our analysis. Post-2009 policy implementation and educational sessions, 46.5% of an eligible 185 inpatients were administered thromboprophylaxis. Following a two-year grace period to allow for policy acceptance, three audits were conducted in 2011 for which an average prophylaxis rate of 62.3% resulted. In 2012, following another round of educational sessions, a 96.7% rate was achieved and maintained ten weeks later. Minimal bleeding risk was observed during this eight year initiative.
  
  
  CONCLUSIONS
  A reproducible 96.7% prophylaxis uptake rate was the result of our perseverance and persistence in believing that culture change was inevitable through continuously collaborating with stakeholders at all levels.
authors.affiliation: Department of Pharmacy, Princess Margaret Cancer Centre, UHN 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Canada. Electronic address: jack.seki@uhn.ca.
authors.forename: Jack T
authors.initials: JT
authors.lastname: Seki
authors.affiliation: Department of Pharmacy, Princess Margaret Cancer Centre, UHN 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.
authors.forename: Triyu
authors.initials: T
authors.lastname: Vather
authors.affiliation: Biostatistics Department, Princess Margaret Cancer Centre, UHN 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, UHN 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kukreti
authors.affiliation: Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, UHN 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: cancer; hospitalized; thromboprophylaxis; venous thromboembolism