title: Venous thromboembolism prophylaxis guideline compliance: a pilot study of augmented medication charts.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a common complication of hospital admission. The incidence of hospital-acquired deep vein thrombosis is approximately 10-40% amongst medical and general surgical patients without prophylaxis. Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients, making hospital-acquired VTE the most common preventable cause of in-hospital death. Studies suggest that prophylactic measures are widely under- and inappropriately used.
  
  
  OBJECTIVE
  We hypothesised that the introduction of a medication chart with a dedicated VTE prophylaxis section would improve compliance with local guidelines.
  
  
  METHODS
  Trial medication charts were piloted over a 4-week period in one surgical and two medical wards. Data on compliance with hospital guidelines were collected before and after introduction using a detailed chart review. The difference in prescribing compliance was assessed with the Chi-squared test.
  
  
  RESULTS
  70 patients were assessed before and 38 after the introduction of the new charts. Initially, only 58.6% (n = 41) of patients' prescriptions were in compliance with local guidelines. In 28.6% (n = 20) of patients, VTE prophylaxis was needed and not prescribed. 7.1% (n = 5) of patients were prescribed an inappropriately low dose of low molecular weight heparin (LMWH) prophylaxis. 2.9% (n = 2) of patients were prescribed inappropriately high dose of LMWH prophylaxis. After introduction of the new medication chart, compliance with guidelines rose to 71% (n = 27, p = 0.09).
  
  
  CONCLUSIONS
  Compliance with VTE guidelines is inadequate. Medication charts with specific sections on VTE assessment and prophylaxis may increase compliance with guidelines.
authors.affiliation: Massachusetts General Hospital, Boston, MA, 02114, USA, robbiecunningham@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Cunningham
authors.forename: A
authors.initials: A
authors.lastname: Murray
authors.forename: J S
authors.initials: JS
authors.lastname: Byrne
authors.forename: L
authors.initials: L
authors.lastname: Hammond
authors.forename: M
authors.initials: M
authors.lastname: Barry
authors.forename: D
authors.initials: D
authors.lastname: Mehigan
authors.forename: S
authors.initials: S
authors.lastname: Sheehan
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D000075202:Contraindications; D003661:Decision Support Techniques; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000517:prevention & control*; D018570:Risk Assessment / Q000379:methods; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight