Translating venous thromboembolism (VTE) prevention evidence into practice: a multidisciplinary evidence implementation project.

摘要

BACKGROUND: Venous thromboembolism (VTE) is an important patient safety issue resulting in significant mortality, morbidity, and health care resource expenditure. Despite the widespread availability of best practice guidelines on VTE prevention, we found that only 49% of our patients were receiving appropriate prophylaxis. AIM: To improve health care professionals' compliance with evidence-based guidelines for VTE prevention in hospitalised patients. DESIGN: A practice improvement methodology was employed to identify, diagnosis, and overcome practice problems. Pre- and post-intervention audits were used to evaluate performance measures. SETTING: The study was conducted from September 2008 until August 2009 and took place in a 250-bed acute-care private hospital in metropolitan Sydney, Australia. INTERVENTION: A change plan was developed that attempted to match organisational barriers to VTE guideline uptake with evidence-based implementation strategies. The strategies used included audit and feedback, documentation aids, staff education initiatives, collaboratively developed hospital VTE prevention policy, alert stickers, and other reminders. RESULTS: The proportion of patients receiving appropriate VTE prophylaxis increased by 19% from 49% to 68% (p= 0.02). Surgical patient prophylaxis increased by 21% from 61% to 82% (p = 0.02) while medical patient prophylaxis increased by 26% from 19% to 45% (p= 0.05). The proportion of patients with a documented VTE risk assessment increased from 0% to 35% (p < 0.001). CONCLUSIONS: The intervention resulted in a 19% overall improvement in prophylaxis rates, which is a significant achievement for any behavioural change intervention. There is, however, still a significant discrepancy between surgical and medical patient prophylaxis rates, which clearly warrants further attention.