Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit

Harry Gibbs,John Fletcher,David Wheatley,Peter Blombery,Renea Collins

doi:10.1186/1477-9560-9-7

Abstract

BackgroundVenous thromboembolism (VTE) is a major health and financial burden. VTE impacts health outcomes in surgical and non-surgical patients. VTE prophylaxis is underutilized, particularly amongst high risk medical patients. We conducted a multicentre clinical audit to determine the extent to which appropriate VTE prophylaxis in acutely ill hospitalized medical patients could be improved via implementation of a multifaceted nurse facilitated educational program.MethodsThis multicentre clinical audit of 15 Australian hospitals was conducted in 2007-208. The program incorporated a baseline audit to determine the proportion of patients receiving appropriate VTE prophylaxis according to best practice recommendations issued by the Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism (ANZ-WP recommendations), followed by a 4-month education intervention program and a post intervention audit. The primary endpoint was to compare the proportion of patients being appropriately managed based on their risk profile between the two audits.ResultsA total of 8774 patients (audit 1; 4399 and audit 2; 4375) were included in the study, most (82.2% audit 1; and 81.0% audit 2) were high risk based on ANZ-WP recommendations. At baseline 37.9% of high risk patients were receiving appropriate thromboprophylaxis. This increased to 54.1% in the post intervention audit (absolute improvement 16%; 95% confidence interval [CI] 11.7%, 20.5%). As a result of the nurse educator program, the likelihood of high risk patients being treated according to ANZ-WP recommendations increased significantly (OR 1.96; 1.62, 2.37).ConclusionUtilization of VTE prophylaxis amongst hospitalized medical patients can be significantly improved by implementation of a multifaceted educational program coordinated by a dedicated nurse practitioner.

Highlights

Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) represents a major public health problem
The most recently published version of these recommendations [15] is based on guidelines from the International Union of Angiology [8] and the American College of Chest Physicians (ACCP) [7] and state that every hospitalized adult patient should be assessed for their risk of VTE
The majority of patients were classified as high VTE risk based on the ANZ-WP recommendations

Summary

Introduction

Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE) represents a major public health problem. VTE is primarily a problem in hospitalized or recently hospitalized patients. The prevention of VTE has been identified nationally and internationally as a priority area for improving patient safety. To support these efforts, a number of evidence-based guidelines have been made available which outline the appropriate use of prophylaxis to prevent VTE in a variety of patient populations [7,8,9,10,11,12,13]. We conducted a multicentre clinical audit to determine the extent to which appropriate VTE prophylaxis in acutely ill hospitalized medical patients could be improved via implementation of a multifaceted nurse facilitated educational program

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Results

Discussion

Conclusion