title: Results of a venous thromboembolism prophylaxis program for hospitalized patients.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed.
  
  
  OBJECTIVE
  The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital.
  
  
  METHODS
  This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level toP<0.05.
  
  
  RESULTS
  With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033).
  
  
  CONCLUSIONS
  The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records.
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Luiz Francisco
authors.initials: LF
authors.lastname: Cardoso
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Daniella Vianna C
authors.initials: DV
authors.lastname: Krokoscz
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Edison Ferreira
authors.initials: EF
authors.lastname: de Paiva
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Ilka Spinola
authors.initials: IS
authors.lastname: Furtado
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mattar
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Marcia Martiniano
authors.initials: MM
authors.lastname: de Souza E Sá
authors.affiliation: Sírio Libanês Hospital, São Paulo, Brazil.
authors.forename: Antonio Carlos Onofre
authors.initials: AC
authors.lastname: de Lira
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D019091:Critical Pathways; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D063886:Patient Discharge Summaries; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011314:Preventive Health Services / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
keywords: deep venous thrombosis; patient safety; prevention and control; pulmonary embolism; quality control