title: Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project.
abstract: BACKGROUND
  Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide.
  
  
  OBJECTIVE
  The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE.
  
  
  METHODS
  A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital.
  
  
  RESULTS
  A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days.
  
  
  CONCLUSIONS
  Overall the project achieved improvements in compliance with best practice standards. A number of delays and barriers contributed to some of the planned interventions not being fully implemented at the time of the follow-up audit. Contributing factors included the lack of electronic capabilities, some processes not being fully embedded into routine clinical workflows, lack of staff time, and identification of an additional organizational barrier relating to practical issues in providing patient education at discharge. A second action cycle is recommended in an attempt to further improve compliance, ensure intervention fidelity, and embed practices into routine daily workflows to positively impact patient and organizational outcomes.
authors.affiliation: 1Centre for Education and Research, Royal Hobart Hospital, Hobart, Tasmania 2School of Health Sciences, University of Tasmania, and Tasmanian Health Service 3Department of Anaesthesia 4Safety and Quality Unit 5Pharmacy Department 6Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania 7Department of Health and Human Services Tasmania, Australia.
authors.forename: Pamela Kathleen
authors.initials: PK
authors.lastname: Sykes
authors.forename: Kenneth
authors.initials: K
authors.lastname: Walsh
authors.forename: Chenqu Mimi
authors.initials: CM
authors.lastname: Darcey
authors.forename: Heather Lee
authors.initials: HL
authors.lastname: Hawkins
authors.forename: Duncan Scott
authors.initials: DS
authors.lastname: McKenzie
authors.forename: Ritam
authors.initials: R
authors.lastname: Prasad
authors.forename: Anita
authors.initials: A
authors.lastname: Thomas
mesh_terms: D055317:Evidence-Based Practice / Q000458:organization & administration*; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000193:education; D009741:Nursing Staff, Hospital / Q000193:education; D010351:Patient Discharge / Q000592:standards*; D063868:Patient Outcome Assessment; D018570:Risk Assessment; D013648:Tasmania; D062606:Tertiary Care Centers; D054556:Venous Thromboembolism / Q000517:prevention & control*