The Effects of a Multifaceted Intervention to Improve Venous Thromboembolism Prophylaxis are Sustained Over Time

Abstract

Background: The majority of venous thromboembolic events occur in hospitalized patients. Although there are several effective regimens, venous thromboembolism (VTE) prophylaxis is still under-utilized in medically-ill patients. In 2003 a multi-faceted quality improvement intervention was implemented to improve the use of VTE prophylaxis. We pre- viously described the significant improvements in VTE prophylaxis in the two years following this intervention. Objective: To determine the longitudinal effects of this quality improvement intervention in prescribing practices for VTE prophylaxis in medically-ill patients. Methods: Since the original intervention in 2002, the only on-going maintenance has been 4 annual lectures. We collected data on 121 medically-ill patients hospitalized in 2006, including risk factors for VTE, pharmacologic agent and dose pre- scribed (or mechanical devices, if uses), and timing of prophylaxis in relation to admission. Results: Overall, 83% were at high-risk for VTE and 77% received prophylaxis, a significant improvement compared to the 2002 pre-intervention cohort (40%, p<0.001) and similar to the 2003 post-intervention cohort (72%). Significantly more patients received preferred regimens for VTE prophylaxis in 2006 compared to 2002. Pneumatic compression de- vices, unfractionated heparin (UFH) 5,000 units TID, low molecular weight heparin (LMWH), and UFH 5,000 units BID were prescribed in 28%, 40%, 38%, and 3% respectively. Prophylaxis was prescribed within the first 24 hours of admis- sion in 88%, 24-48 hours in 8%, and after 48 hours in 4%. Conclusions: We have demonstrated that a multifaceted quality improvement intervention leads to a sustained improve- ment in the use of preferred VTE prophylaxis prescribing practices. The maintenance of these effects has been minimal, consisting of four 1-hour long educational sessions per year targeted to clinical pharmacists and medicine residents.