Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high‐risk medical patients. Issue 2 (February 2014)

• Record Type: Journal Article
• Authors: Yates, M.; Reddy, M.; Machumpurath, B.; Phelps, G.; Hampson, S.‐A.
• Is Part Of: Internal medicine journal. Volume 44:Issue 2(2014)
• Page Start: 190
• Page End: 194
• Publication Date: 2014-02
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12346
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12346-sec-9001" sec-type="section"> <title>Background</title> <p>Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well‐established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor.</p> </sec> <sec id="imj12346-sec-9002" sec-type="section"> <title>Aim</title> <p>The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients.</p> </sec> <sec id="imj12346-sec-9003" sec-type="section"> <title>Methods</title> <p>We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with 'VTE avoidance' preprinted in the first medication box.</p> </sec> <sec id="imj12346-sec-9004" sec-type="section"> <title>Results</title> <p>Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high‐risk cohort, 34.9% (confidence interval (CI) 28–42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37–49%) of the high‐risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI −1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66–92%) of the high‐risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24–54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55–86%).</p> </sec> <sec id="imj12346-sec-9005" sec-type="section"> <title>Conclusions</title> <p>This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.</p> </sec> </abstract>