Adherence to Inpatient Venous Thromboembolism Prophylaxis: A Single Institution's Concurrent Review. (July 2019)

• Record Type: Journal Article
• Authors: Bauer, Tyler M.; Johnson, Adam P.; Dukleska, Katerina; Beck, Johanna; Dworkin, Myles S.; Patel, Kamini; Cowan, Scott W.; Merli, Geno J.
• Is Part Of: American journal of medical quality. Volume 34:Number 4(2019)
• Page Start: 402
• Page End: 408
• Publication Date: 2019-07
• Subjects: venous thromboembolism -- prophylaxis adherence -- ambulation -- deep vein thromboembolism; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860618808378
• Languages: English
• ISSNs: 1062-8606

Abstract

Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated. Seventy-six patients consented for participation. Nurse documented adherence was 66% (29/44), 44% (27/61), and 89% (50/56) for mechanical, ambulatory, and chemoprophylactic prophylaxis, respectively. Patient report and nurse documentation showed moderate agreement for mechanical and no agreement for ambulatory adherence (κ = 0.51 and 0.07, respectively). Concurrent review using a cloud-based tool can provide robust, timely, and relevant information on adherence to recommended VTE prophylaxis. Iterative concurrent reviews can guide efforts to improve adherence and reduce rates of hospital-acquired VTE.